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California 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
$3,981.07 / $10,000.00 / $21,877.62
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,630.78 / $6,165.95 / $13,803.84
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.07 / $812.83 / $17,782.79
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18,620.87 / $18,620.87 / $18,620.87
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$389.05 / $416.87 / $588.84
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.74 / $457.09 / $912.01
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.95 / $56.23 / $53,703.18
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$398.11 / $501.19 / $870.96
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,762.47 / $14,125.38 / $28,840.32