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Virginia 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
$507.52 / $3,226.00 / $8,294.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,900.00 / $13,875.00 / $15,752.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$640.00 / $640.00 / $767.96
Cigna
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$76.80 / $76.80 / $76.80
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$842.23 / $1,089.14 / $1,287.17
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$507.52 / $917.55 / $1,430.51
Medcost
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$141.93 / $163.07 / $332.88
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$446.40 / $605.19 / $2,167.57
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,408.00 / $13,296.00 / $26,537.00