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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
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,332.54 / $9,332.54 / $9,332.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$512.86 / $512.86 / $645.65
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.19 / $416.87 / $616.60
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$446.68 / $1,000.00 / $3,548.13