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Hawaii 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
$1,778.28 / $4,466.84 / $4,466.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.00 / $616.60 / $1,096.48
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$446.68 / $489.78 / $741.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.74 / $776.25 / $1,096.48
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $776.25 / $3,981.07
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.12 / $831.76 / $1,047.13
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,019.95 / $3,019.95 / $3,019.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.19 / $602.56 / $1,548.82
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.38 / $2,570.40 / $6,165.95