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Montana 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
Professional
Modifier
Low / Median / High Price
$47.41 / $55.09 / $78.37
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$383.65 / $77,999.99 / $94,999.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.02 / $82.02 / $82.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.45 / $83.76 / $166.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.26 / $69.31 / $210.06
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.30 / $52.37 / $115.70
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.79 / $82.02 / $125.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.92 / $89.32 / $104.72