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Hawaii 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
$2,528.00 / $2,747.00 / $6,084.00
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,149.96 / $1,254.50 / $1,463.59
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,028.00 / $3,028.00 / $3,028.00