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Montana rates for HCPCS 95970

Electronic analysis of implanted neurostimulator pulse generator/transmitter (eg, contact group[s], interleaving, amplitude, pulse width, frequency [Hz], on/off cycling, burst, magnet mode, dose lockout, patient selectable parameters, responsive neurostimulation, detection algorithms, closed loop parameters, and passive parameters) by physician or other qualified health care professional; with brain, cranial nerve, spinal cord, peripheral nerve, or sacral nerve, neurostimulator pulse generator/transmitter, without programming

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.83 / $177.83 / $177.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.98 / $25.12 / $74.13
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.13 / $66,069.34 / $95,499.26
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.18 / $29.51 / $29.51
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.18 / $34.67 / $112.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.62 / $28.18 / $93.33
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.90 / $32.36 / $107.15
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.90 / $32.36 / $107.15
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.98 / $28.18 / $81.28
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.99 / $47.86 / $79.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.99 / $33.88 / $93.33