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Utah rates for HCPCS 64629

Thermal destruction of intraosseous basivertebral nerve, including all imaging guidance; each additional vertebral body, lumbar or sacral (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,698.24 / $3,388.44 / $4,570.88
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $288.40 / $426.58
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,071.52 / $4,466.84 / $5,128.61