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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
$100.00 / $100.00 / $15,774.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,992.79 / $9,992.00 / $19,050.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$469.76 / $469.76 / $469.76
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,399.00 / $12,399.00 / $12,399.00