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Utah rates for HCPCS 63663

Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,202.26 / $3,162.28 / $6,025.60
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,232.93 / $12,022.64 / $28,183.83
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $1,288.25 / $1,905.46
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,019.95 / $5,128.61 / $15,848.93