go back

Utah rates for HCPCS L8687

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,979.44 / $5,979.44 / $5,979.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,287.12 / $5,979.44 / $7,479.70
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 / $7,551.49 / $9,742.50
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.00 / $45.00 / $60.00
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,023.79 / $12,220.17 / $15,659.14
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,344.61 / $9,344.61 / $9,344.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,515.01 / $5,558.95 / $13,254.43