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Virginia 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
Professional
Modifier
Low / Median / High Price
$89.00 / $89.00 / $119.29
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.86 / $104.86 / $104.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.90 / $22.90 / $22.90
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$228.00 / $228.00 / $252.00
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.67 / $61.13 / $105.54
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$104.86 / $116.29 / $4,071.00
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.86 / $116.29 / $4,071.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.92 / $62.92 / $104.86