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Oklahoma 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
$1,392.00 / $4,856.00 / $14,100.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,444.76 / $15,004.39 / $23,706.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15,353.75 / $15,353.75 / $15,353.75
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$407.20 / $663.01 / $13,541.98
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,209.00 / $9,200.00 / $15,388.63