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Minnesota 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
$1.00 / $160.78 / $815.91
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.09 / $138.33 / $142.61
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.93 / $31.04 / $71.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.23 / $12.66 / $13.20
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.53 / $28.44 / $67.88
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.13 / $10.13 / $12.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.67 / $57.67 / $100.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.43 / $69.91 / $168.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.94 / $69.91 / $168.85