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Michigan 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
$586.82 / $4,933.00 / $5,757.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16,465.25 / $23,898.62 / $57,452.11
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$484.57 / $4,933.00 / $5,757.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,561.00 / $8,995.00 / $12,767.00