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Maine rates for HCPCS L8687

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,871.31 / $7,519.60 / $7,519.60
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11,151.10 / $11,848.05 / $15,054.18
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,551.49 / $7,551.49 / $7,551.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,418.77 / $6,418.77 / $7,551.49
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15,290.18 / $15,290.18 / $15,290.18
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,519.60 / $7,519.60 / $11,290.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,713.38 / $8,403.64 / $14,766.43