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Maryland 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
$0.98 / $913.05 / $4,824.39
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$292.17 / $730.44 / $1,243.41
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$2,322.69 / $2,322.69 / $2,322.69
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$317.73 / $401.84 / $459.31
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$507.00 / $641.21 / $4,926.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$312.70 / $676.98 / $1,554.19
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$737.01 / $956.83 / $1,533.65
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,003.00 / $1,003.00 / $2,156.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$624.95 / $1,066.04 / $1,856.99
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.73 / $852.99 / $1,052.86