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Utah 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
$1,584.89 / $4,466.84 / $8,511.38
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20,417.38 / $23,988.33 / $54,954.09
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $645.65 / $912.01
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,019.95 / $5,128.61 / $15,848.93