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Utah rates for HCPCS 0589T

Electronic analysis with simple programming of implanted integrated neurostimulation system for bladder dysfunction (eg, electrode array and receiver), including contact group(s), amplitude, pulse width, frequency (Hz), on/off cycling, burst, dose lockout, patient-selectable parameters, responsive neurostimulation, detection algorithms, closed-loop parameters, and passive parameters, when performed by physician or other qualified health care professional, posterior tibial nerve, 1-3 parameters

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.99 / $47.99 / $47.99
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.99 / $57.39 / $107.15
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $45.00 / $60.00
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$149.41 / $186.30 / $267.47
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.01 / $66.53 / $78.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.08 / $60.11 / $86.80