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New Hampshire 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
$72.63 / $72.63 / $73.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.80 / $53.95 / $67.09
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.58 / $52.58 / $52.58
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.20 / $65.20 / $98.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.05 / $90.02 / $176.22
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.45 / $91.09 / $172.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.48 / $81.56 / $159.41
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.82 / $49.52 / $66.44