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Texas rates for HCPCS 63688

Revision or removal of implanted spinal neurostimulator pulse generator or receiver, with detachable connection to electrode array

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$488.00 / $2,128.00 / $7,513.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,591.44 / $4,722.75 / $9,444.37
Baylor Scott & White
Facility/Professional
Facility
Modifier
Low / Median / High Price
$317.00 / $1,555.47 / $4,357.68
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$297.10 / $2,547.63 / $2,547.63
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$341.27 / $341.27 / $341.27
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,120.64 / $11,500.00 / $12,000.00
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$307.50 / $453.34 / $816.01
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$307.50 / $456.47 / $818.24
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,634.00 / $4,345.00 / $10,600.00