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Pennsylvania 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
$715.67 / $4,048.00 / $10,247.00
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,531.00 / $27,840.00 / $46,296.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$469.76 / $469.76 / $469.76
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,183.76 / $23,743.75 / $34,852.73
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$715.67 / $4,894.00 / $10,247.00
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$469.76 / $469.76 / $469.76
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$445.69 / $445.69 / $498.83
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,228.00 / $4,563.00 / $8,261.00