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Montana rates for HCPCS 64628

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

Insurance Carrier
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46,773.51 / $81,283.05 / $95,499.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$645.65 / $645.65 / $645.65
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$660.69 / $724.44 / $794.33
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$363.08 / $501.19 / $912.01