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Maryland rates for HCPCS L8687

Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,981.07 / $5,888.44 / $10,964.78
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11,748.98 / $11,748.98 / $11,748.98
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,585.78 / $7,585.78 / $7,585.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,456.54 / $6,456.54 / $7,585.78
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,762.47 / $10,000.00 / $16,218.10
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,413.10 / $13,803.84 / $14,125.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,495.41 / $8,912.51 / $14,125.38
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11,220.18 / $11,220.18 / $11,220.18