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Wisconsin 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
$71.20 / $89.00 / $126.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.03 / $31.59 / $41.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.13 / $12.66 / $20.16
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.67 / $57.67 / $86.51
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.67 / $57.67 / $100.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.92 / $83.89 / $139.81
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $58.40 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.67 / $57.67 / $86.51
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,900.00 / $5,900.00 / $5,900.00
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.00 / $65.00 / $117.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.16 / $634.28 / $634.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.92 / $83.89 / $139.81