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Indiana 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
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.00 / $89.00 / $171.77
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.00 / $89.00 / $126.38
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$183.67 / $183.67 / $238.09
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$183.67 / $220.40 / $275.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.86 / $117.48 / $117.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.94 / $83.89 / $139.81