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Ohio 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 / $350.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.67 / $57.67 / $57.67
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.00 / $102.35 / $164.12
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$183.67 / $183.67 / $224.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.64 / $181.16 / $181.16
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.64 / $104.86 / $104.86
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.00 / $50.00 / $60.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.43 / $83.89 / $111.85