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Utah 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
$46.85 / $66.72 / $66.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.10 / $46.85 / $66.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.85 / $65.94 / $113.40
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.35 / $61.47 / $78.15
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
$44.20 / $67.78 / $112.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.48 / $62.00 / $88.66