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New Hampshire rates for HCPCS 22586

Arthrodesis, pre-sacral interbody technique, including disc space preparation, discectomy, with posterior instrumentation, with image guidance, includes bone graft when performed, L5-S1 interspace

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,398.83 / $4,466.84 / $20,892.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,778.28 / $2,238.72 / $3,981.07
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63,095.73 / $77,624.71 / $87,096.36
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,995.26 / $3,890.45 / $5,495.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,290.87 / $3,090.30 / $6,165.95
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,589.25 / $12,589.25 / $12,589.25
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,344.23 / $3,467.37 / $5,248.07
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,589.25 / $12,589.25 / $12,589.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,137.96 / $3,090.30 / $5,623.41
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,513.56 / $1,513.56 / $2,398.83