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Washington rates for HCPCS 64628

Thermal destruction of intraosseous basivertebral nerve, including all imaging guidance; first 2 vertebral bodies, lumbar or sacral

Facilitymedian $1,175 · 10th–90th $562–$30,2000%5%10th90th$1,175$500.0$2.0K$10.0K$50.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$776.25 / $10,232.93 / $21,877.62
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$28,183.83 / $36,307.81 / $70,794.58
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$707.95 / $870.96 / $26,915.35
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$501.19 / $891.25 / $23,442.29
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$478.63 / $812.83 / $812.83
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$562.34 / $616.60 / $6,760.83
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$26,915.35 / $36,307.81 / $70,794.58
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$4,677.35 / $38,018.94 / $72,443.60