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Nebraska 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
$4,241.22 / $10,431.19 / $21,899.37
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,828.40 / $10,296.48 / $19,916.72
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,286.02 / $14,286.02 / $14,286.02
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$407.42 / $692.61 / $9,696.00
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$767.95 / $1,316.74 / $19,048.02
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,939.00 / $8,158.00 / $9,496.00