go back

Ohio 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
$724.44 / $4,168.69 / $10,715.19
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$4,897.79 / $6,760.83 / $12,589.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.12 / $691.83 / $1,819.70
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$676.08 / $1,047.13 / $2,691.53
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $302.00 / $549.54
Ambetter
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$446.68 / $1,096.48 / $2,187.76
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,137.96 / $7,413.10 / $30,199.52
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.59 / $436.52 / $707.95
Anthem BCBS
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$489.78 / $645.65 / $1,071.52
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$295.12 / $295.12 / $346.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21,379.62 / $21,379.62 / $21,379.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.13 / $645.65 / $1,380.38
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,011.87 / $12,302.69 / $21,379.62
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.13 / $645.65 / $1,380.38
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $144.54
SummaCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $7,762.47
SummaCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.84 / $691.83 / $1,318.26
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,265.80 / $9,332.54 / $14,791.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.42 / $588.84 / $1,380.38