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Montana rates for HCPCS 95976

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 cranial nerve neurostimulator pulse generator/transmitter programming by physician or other qualified health care professional

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.00 / $40.99 / $58.85
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$289.00 / $77,999.99 / $94,999.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.52 / $61.52 / $61.52
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.47 / $64.11 / $127.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.60 / $52.18 / $159.69
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.42 / $39.72 / $86.66
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.50 / $61.52 / $94.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.65 / $68.45 / $80.25