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Missouri 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
$1,760.00 / $5,389.00 / $9,823.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$821.00 / $1,963.00 / $4,852.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$378.42 / $637.35 / $6,120.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,941.00 / $4,390.00 / $11,621.00