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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
$47,000.00 / $81,499.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$650.41 / $650.41 / $650.41
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$318.87 / $380.28 / $650.41
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$511.66 / $511.66 / $511.66