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Arizona rates for HCPCS 64561

Percutaneous implantation of neurostimulator electrode array; sacral nerve (transforaminal placement) including image guidance, if performed

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,373.92 / $3,617.00 / $7,283.00
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$7,191.76 / $7,191.76 / $7,191.76
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.13 / $684.28 / $1,596.09
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$516.03 / $516.03 / $6,295.50
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$672.35 / $2,531.19 / $4,140.09
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.19 / $502.45 / $822.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$318.04 / $663.97 / $1,579.60
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$291.72 / $684.93 / $8,241.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$704.88 / $1,200.04 / $8,263.84
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,279.00 / $9,437.00 / $23,087.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$683.52 / $977.45 / $1,650.22