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New Hampshire 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
$2,398.83 / $3,890.45 / $15,848.93
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,332.54 / $10,471.29 / $19,952.62
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,302.69 / $12,302.69 / $12,302.69
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,302.69 / $12,302.69 / $12,302.69
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$338.84 / $338.84 / $537.03