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Sacral Nerve Stimulation Test Lead

Ohio rates for HCPCS A4290

Sacral nerve stimulation test lead, each

Rates data updated July 2026.

Facilitymedian $58 · 10th–90th $58$1050%50%90th$58Professionalmedian $58 · 10th–90th $58$1350%20%40%90th$58$2.0$10.0$50.0$200.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$57.54
Median
$57.54
Typical High
$104.71
Aetna
Setting
Professional
Modifier
Global
Typical Low
$57.54
Median
$57.54
Typical High
$57.54
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$89.13
Median
$102.33
Typical High
$158.49
Cigna
Setting
Facility
Modifier
Global
Typical Low
$117.49
Median
$117.49
Typical High
$117.49
Cigna
Setting
Professional
Modifier
Global
Typical Low
$17.78
Median
$181.97
Typical High
$208.93
Medical Mutual of Ohio
Setting
Professional
Modifier
Global
Typical Low
$17.78
Median
$17.78
Typical High
$104.71
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$50.12
Typical High
$60.26
SummaCare
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$60.26
Typical High
$75.86
United
Setting
Facility
Modifier
Global
Typical Low
$104.71
Median
$104.71
Typical High
$112.20
United
Setting
Professional
Modifier
Global
Typical Low
$41.69
Median
$83.18
Typical High
$112.20