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Indiana 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
$974.82 / $2,505.29 / $16,042.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,497.00 / $26,400.00 / $56,650.00
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$939.69 / $1,221.59 / $1,409.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18,884.41 / $18,884.41 / $22,385.62
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,058.00 / $12,330.00 / $17,416.00