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Maryland rates for HCPCS 64628

Thermal destruction of intraosseous basivertebral nerve, including all imaging guidance; first 2 vertebral bodies, lumbar or sacral

Insurance Carrier
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$507.00 / $641.21 / $8,991.70
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$421.76 / $510.55 / $634.16
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$445.87 / $918.00 / $2,156.00