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Wisconsin 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
$0.95 / $602.56 / $14,454.40
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,011.87 / $8,317.64 / $13,489.63
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$758.58 / $891.25 / $1,412.54
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$338.84 / $602.56 / $3,548.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$346.74 / $676.08 / $11,220.18
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.63 / $724.44 / $1,122.02
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,413.10 / $10,964.78 / $10,964.78
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,606.93 / $10,232.93 / $12,589.25