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Utah 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
$63.84 / $63.84 / $64.63
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.46 / $54.68 / $83.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.58 / $76.87 / $113.71
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
$149.41 / $186.30 / $267.47
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.53 / $78.23 / $100.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.74 / $67.76 / $95.47