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Tennessee 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
$974.00 / $2,940.00 / $7,602.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,003.00 / $7,194.00 / $13,734.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $54,020.20 / $54,020.20
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,238.00 / $7,695.00 / $13,089.00