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Arizona rates for HCPCS 22867

Insertion of interlaminar/interspinous process stabilization/distraction device, without fusion, including image guidance when performed, with open decompression, lumbar; single level

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,591.61 / $4,474.00 / $7,960.15
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,763.75 / $6,640.00 / $10,860.55
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$992.45 / $1,394.16 / $9,251.00
Medica
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$262.95 / $262.95 / $7,575.71
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,255.00 / $7,205.00 / $11,396.00