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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
$640.05 / $4,312.00 / $8,194.00
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20,314.50 / $25,330.44 / $36,365.48
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,680.00 / $4,912.00 / $15,824.00