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Washington rates for HCPCS A4290

Sacral nerve stimulation test lead, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.67 / $130.91 / $136.68
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.67 / $57.67 / $99.77
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $117.00
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.00 / $142.61 / $296.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.73 / $10.73 / $12.86
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.23 / $18.23 / $18.23
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $50.00 / $75.00
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79,999.20 / $79,999.20 / $79,999.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.92 / $62.92 / $104.86
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.00 / $89.00 / $320.62