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Pennsylvania rates for HCPCS 22515

Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device (eg, kyphoplasty), 1 vertebral body, unilateral or bilateral cannulation, inclusive of all imaging guidance; each additional thoracic or lumbar vertebral body (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$262.08 / $2,561.00 / $6,012.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.34 / $1,810.89 / $5,084.45
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,000.00 / $8,639.91 / $79,506.39
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,620.40 / $4,182.89 / $7,809.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$369.23 / $369.23 / $369.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$233.74 / $500.87 / $6,316.03
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,228.14 / $4,317.72 / $5,575.87
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,584.43 / $1,996.67 / $13,089.87
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$228.42 / $228.42 / $228.42
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$307.58 / $2,667.00 / $7,197.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.75 / $1,810.89 / $7,033.23
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$250.50 / $250.50 / $6,717.70
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$369.23 / $369.23 / $369.23
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$233.74 / $589.50 / $6,377.50
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$212.60 / $254.65 / $4,613.24
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.60 / $2,775.18 / $3,104.83
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$162.00 / $650.00 / $4,430.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,428.98 / $4,571.97 / $7,334.95