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Arizona rates for HCPCS 64628

Thermal destruction of intraosseous basivertebral nerve, including all imaging guidance; first 2 vertebral bodies, lumbar or sacral

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,965.00 / $4,521.00 / $7,963.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,118.28 / $4,636.24 / $6,885.96
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$371.34 / $568.07 / $9,383.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,315.00 / $7,341.00 / $11,396.00