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Virginia 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
$646.54 / $2,561.00 / $8,294.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,032.00 / $6,548.00 / $7,221.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$341.27 / $341.27 / $420.00
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$284.92 / $364.70 / $430.44
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$378.38 / $489.96 / $723.71
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$348.50 / $476.21 / $1,743.19
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,121.00 / $9,270.00 / $17,192.00