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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
$512.86 / $2,630.27 / $8,317.64
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,748.98 / $14,791.08 / $15,848.93
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$645.65 / $645.65 / $645.65
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $1,202.26 / $1,412.54
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,288.25 / $2,137.96
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$457.09 / $870.96 / $1,479.11
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$436.52 / $602.56 / $10,000.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,413.10 / $12,882.50 / $29,512.09