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Michigan 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
$134.85 / $195.16 / $267.25
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.50 / $18.98 / $24.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.73 / $22.90 / $181.16
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.67 / $134.19 / $154.31
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.67 / $134.19 / $171.37
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $55.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.19 / $83.89 / $139.81