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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

Facilitymedian $9,772 · 10th–90th $2,399–$15,8490%10%10th90th$9,772$100.0$500.0$2.0K$10.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,398.83 / $3,890.45 / $15,848.93
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$9,332.54 / $10,471.29 / $19,952.62
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$12,302.69 / $12,302.69 / $12,302.69
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$12,302.69 / $12,302.69 / $12,302.69
Well Sense
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$446.68 / $457.09 / $537.03