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Hawaii 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
$2,528.00 / $2,747.00 / $6,084.00
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$450.05 / $490.97 / $572.79
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,028.00 / $3,028.00 / $3,028.00