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Arizona rates for HCPCS A4290

Sacral nerve stimulation test lead, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.67 / $57.67 / $57.67
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.67 / $57.67 / $57.67
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$104.80 / $247.59 / $612.29
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.15 / $104.80 / $247.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.23 / $10.23 / $12.86
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.67 / $63.44 / $117.07
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.67 / $62.92 / $104.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.43 / $62.92 / $104.86