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Utah 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
Facility
Modifier
Low / Median / High Price
$47.92 / $48.70 / $48.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.00 / $40.38 / $65.67
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.60 / $57.70 / $85.67
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.84 / $32.34 / $43.66
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.21 / $72.58 / $104.20
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.98 / $58.73 / $75.39
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.58 / $47.52 / $71.20