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Ohio 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
$718.11 / $8,399.00 / $11,561.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,097.00 / $8,010.00 / $36,529.00
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$362.15 / $459.94 / $575.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21,571.00 / $21,571.00 / $21,571.00
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$469.76 / $469.76 / $469.76
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,227.00 / $8,928.00 / $14,134.00