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Virginia 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
$620.84 / $4,390.00 / $13,099.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$303.24 / $696.33 / $1,277.34
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$2,322.69 / $2,322.69 / $2,322.69
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$49,208.00 / $62,509.00 / $67,760.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$282.70 / $356.06 / $594.40
Anthem BCBS
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$417.65 / $534.09 / $891.60
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$317.73 / $433.99 / $5,113.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$515.84 / $515.84 / $640.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$334.24 / $735.19 / $1,584.99
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$681.01 / $881.31 / $1,041.55
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$321.43 / $697.57 / $1,498.42
Medcost
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$1,076.34 / $1,942.79 / $3,226.82
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,019.00 / $1,179.00 / $1,775.00
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$306.55 / $488.17 / $1,464.36
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$775.66 / $1,193.97 / $3,442.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,408.00 / $13,296.00 / $34,314.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$604.10 / $1,107.23 / $1,999.27