CPT 64628
Destruction by Neurolytic Agent - Back
Current code29 hospitals with prices
What Washington hospitals publish for this code
Medicare Advantage: Rate for a private Medicare Advantage plan. Applies only to members of that plan.
| Hospital | Medicare Advantage rates (lowest – highest) | Cash price | List price (before discounts) |
|---|---|---|---|
| Capital Medical Center | $14,570 – $16,027 | — | — |
| Deaconess Medical Center | $14,021 – $15,423 | — | — |
| EvergreenHealth Medical Center | $14,681 – $14,966 | $34,326 | $42,907 |
| Harborview Medical Center | $14,867 – $16,354 | $936 | $1,338 |
| Island Hospital | $15,322 – $16,242 | — | — |
| Kadlec Regional Medical Center | $14,307 – $17,168 | — | — |
| Legacy Salmon Creek Medical Center | $14,736 – $16,024 | — | — |
| Mary Bridge Children's Hospital | $14,684 – $16,152 | — | — |
| MultiCare Auburn Medical Center | $14,611 – $16,072 | — | — |
| MultiCare Covington Medical Center | $14,611 – $16,072 | — | — |
| MultiCare Good Samaritan Hospital | $14,684 – $16,152 | — | — |
| MultiCare Valley Hospital | $14,441 – $15,423 | — | — |
| Olympic Medical Center | $16,089 – $20,685 | — | — |
| Overlake Hospital Medical Center & Clinics | $14,909 – $15,505 | — | — |
| Prov Sacred HRT Med Ctr & Childs Hosp. | $14,307 – $17,168 | $37,250 | $53,214 |
| Providence Centralia Hospital | $14,867 – $23,787 | — | — |
| Providence Holy Family Hospital | $14,307 – $15,737 | $32,573 | $46,533 |
| Providence Regional Medical Center Everett | $14,621 – $16,083 | — | — |
| Providence St Mary Medical Center | $14,307 – $15,737 | — | — |
| Providence St Peter Hospital | $14,766 – $23,625 | — | — |
| Swedish Edmonds Hospital | $14,621 – $17,545 | — | — |
| Swedish Issaquah | $14,909 – $17,891 | — | — |
| Swedish Medical Center | $14,867 – $17,840 | — | — |
| Swedish Medical Center / Cherry Hill | $14,867 – $17,840 | — | — |
| Tacoma General Allenmore Hospital | $14,684 – $16,152 | — | — |
| University of Washington Medical Ctr | $14,867 – $16,354 | $713 | $1,018 |
| Virginia Mason Medical Center | $9.38 – $14,716 | $7,162 | $14,043 |
| Wellfound Behavioral Health Hospital | — | — | — |
| Yakima Valley Memorial | $15,016 – $16,818 | — | — |
Medicare (traditional) reference
Only for people on original Medicare. These are CMS’s 2026 amounts. They aren’t what private insurance or cash patients pay.
- Doctor's fee, Seattle (King County)
- $396 in a hospital or surgery center
- Doctor's fee, rest of Washington
- $368 in a hospital or surgery center
- Hospital outpatient payment (national)
- $13,117 (APC 5115)
- Surgery center payment (national)
- $9,891