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New York 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
$624.53 / $4,905.00 / $10,965.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,977.00 / $9,808.00 / $16,411.00
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$642.49 / $642.49 / $642.49
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$469.76 / $469.76 / $469.76
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$295.51 / $445.74 / $1,048.33
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$385.05 / $385.05 / $385.05
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,216.78 / $12,216.78 / $12,216.78
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$469.76 / $555.00 / $597.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,705.00 / $6,344.00 / $14,069.00
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$481.23 / $481.23 / $653.29