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Utah rates for HCPCS 95972

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 complex 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
$90.54 / $90.54 / $123.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.78 / $68.48 / $123.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.01 / $89.39 / $140.60
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.35 / $61.32 / $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
$46.12 / $72.30 / $163.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.60 / $82.63 / $152.19