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Montana rates for HCPCS 95971

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 simple spinal cord or peripheral nerve (eg, sacral nerve) neurostimulator pulse generator/transmitter programming by physician or other qualified health care professional

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$226.00 / $226.00 / $226.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.01 / $50.49 / $75.62
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$291.51 / $77,999.99 / $94,999.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.47 / $60.47 / $75.72
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.47 / $75.72 / $128.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.82 / $60.47 / $161.13
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.54 / $47.84 / $104.71
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.61 / $69.88 / $112.46
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.12 / $84.96 / $103.94