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Idaho 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
$1,149.93 / $4,500.00 / $17,856.43
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,433.57 / $11,433.57 / $11,465.72
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$380.28 / $727.13 / $1,314.22
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24,430.98 / $34,178.19 / $43,515.35
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,600.00 / $11,800.00 / $29,092.00