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Pennsylvania rates for HCPCS 22842

Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires); 3 to 6 vertebral segments (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$790.28 / $1,978.00 / $8,104.00
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,531.00 / $27,840.00 / $46,296.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$866.56 / $866.56 / $866.56
Cigna
Facility/Professional
Facility
Modifier
62
Low / Median / High Price
$531.50 / $531.50 / $531.50
Cigna
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$85.04 / $85.04 / $85.04
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,978.36 / $2,601.73 / $3,261.42
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$705.94 / $1,978.00 / $7,799.00
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$866.56 / $866.56 / $866.56
Priority Health
Facility/Professional
Facility
Modifier
62
Low / Median / High Price
$531.50 / $531.50 / $531.50
Priority Health
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$85.04 / $85.04 / $85.04
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$743.28 / $743.28 / $839.96
UPMC Health Plan
Facility/Professional
Facility
Modifier
62
Low / Median / High Price
$795.63 / $795.63 / $795.63
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$162.00 / $650.00 / $3,742.00