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Pennsylvania 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
$594.00 / $3,142.00 / $8,962.45
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$1,923.04 / $28,525.19 / $49,344.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$278.76 / $646.96 / $1,243.41
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$516.03 / $1,030.05 / $2,890.59
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,850.00 / $16,455.00 / $26,582.19
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$694.07 / $720.26 / $1,469.75
Capital Blue Cross
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$1,041.09 / $1,080.39 / $2,204.61
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$515.84 / $515.84 / $515.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$319.37 / $654.78 / $1,496.06
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$835.11 / $1,115.49 / $1,442.46
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,599.00 / $12,774.62 / $22,711.41
Highmark BCBS
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$2,431.67 / $18,000.78 / $60,686.55
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$599.08 / $3,748.00 / $8,451.00
Martin's Point
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$1,923.04 / $7,281.00 / $49,344.83
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$287.82 / $691.58 / $1,596.09
Martin's Point
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$516.03 / $965.29 / $2,890.59
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$955.30 / $955.30 / $1,704.80
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$515.84 / $515.84 / $515.84
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$322.77 / $676.98 / $1,535.20
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$295.61 / $653.46 / $1,288.27
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.61 / $702.35 / $769.54
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,468.00 / $4,563.00 / $9,631.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$727.04 / $1,076.81 / $1,671.10