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Montana rates for HCPCS 95984

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 brain neurostimulator pulse generator/transmitter programming, each additional 15 minutes face-to-face time with physician or other qualified health care professional (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.69 / $46.20 / $67.12
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$316.41 / $77,999.99 / $94,999.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.34 / $68.34 / $68.34
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.30 / $70.23 / $139.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.70 / $57.21 / $179.84
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.65 / $43.36 / $96.11
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.38 / $68.34 / $104.83
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.42 / $42.42 / $42.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.93 / $74.83 / $87.73