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Louisiana 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
$678.00 / $2,447.00 / $5,260.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,142.44 / $19,262.49 / $28,063.06
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,391.30 / $11,391.30 / $11,391.30
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$400.00 / $400.00 / $400.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,305.00 / $7,100.00 / $22,240.00