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Arizona rates for HCPCS 95977

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 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
$2,095.40 / $2,095.40 / $2,095.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.30 / $51.48 / $77.55
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.28 / $43.28 / $43.28
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.26 / $202.46 / $335.34
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.40 / $45.88 / $56.59
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.89 / $80.89 / $80.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.28 / $71.54 / $119.89
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.56 / $51.48 / $101.04
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.74 / $64.68 / $332.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.74 / $56.98 / $110.60