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Missouri 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
$451.88 / $4,147.00 / $8,118.00
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$1,887.00 / $5,236.50 / $34,909.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$296.43 / $614.28 / $1,239.22
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$516.03 / $1,419.14 / $3,138.97
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,088.00 / $4,358.00 / $10,713.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$325.05 / $459.77 / $664.66
Anthem BCBS
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$487.57 / $682.47 / $996.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,083.00 / $10,223.00 / $15,638.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$336.29 / $735.75 / $1,544.91
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$301.26 / $790.57 / $5,187.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$805.56 / $1,498.90 / $8,263.84
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,426.00 / $5,048.00 / $46,908.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$709.20 / $1,159.17 / $1,849.70