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New Hampshire rates for HCPCS L8687

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,220.18 / $11,220.18 / $13,489.63
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,715.35 / $6,309.57 / $13,489.63
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11,220.18 / $11,220.18 / $11,220.18
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
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15,135.61 / $15,135.61 / $26,915.35
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,754.40 / $7,762.47 / $13,803.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,890.45 / $10,715.19 / $15,135.61