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Maine 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
$1,384.85 / $3,458.76 / $6,316.99
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$7,198.17 / $7,198.17 / $7,198.17
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$358.00 / $571.28 / $1,109.66
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$334.03 / $392.98 / $595.70
Anthem BCBS
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$501.05 / $589.47 / $893.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$375.73 / $757.13 / $1,633.78
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$374.69 / $882.52 / $1,416.80
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,729.38 / $6,316.99 / $13,625.47
Martin's Point
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$7,198.17 / $7,198.17 / $7,198.17
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$358.00 / $571.28 / $1,122.57
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.85 / $1,069.84 / $1,489.55