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South Dakota 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
$436.52 / $4,365.16 / $4,897.79
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$489.78 / $691.83 / $933.25
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $1,047.13 / $1,047.13
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $707.95 / $891.25
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,370.32 / $5,370.32 / $5,370.32