go back

Indiana 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
$418.40 / $1,854.00 / $16,042.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,646.00 / $24,214.00 / $45,778.00
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$374.89 / $414.25 / $468.61
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,763.79 / $12,763.79 / $15,130.22
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,058.00 / $12,296.00 / $17,416.00