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Pennsylvania 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
Facility
Modifier
Low / Median / High Price
$46.55 / $47.29 / $121.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.19 / $44.27 / $83.76
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.87 / $51.87 / $51.87
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,000.00 / $8,639.91 / $79,506.39
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.00 / $44.63 / $77.45
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$69.27 / $69.27 / $69.27
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.57 / $55.99 / $96.30
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.37 / $62.73 / $85.44
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.52 / $49.94 / $72.80
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.55 / $53.38 / $1,812.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.67 / $48.32 / $130.82
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.00 / $48.00 / $89.30
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$69.27 / $69.27 / $69.27
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.57 / $56.15 / $99.45
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.21 / $42.53 / $49.47
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.32 / $42.66 / $49.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.51 / $50.98 / $87.70