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Missouri 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
$1,760.00 / $5,691.00 / $13,151.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,114.00 / $6,000.00 / $13,384.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$911.52 / $1,521.65 / $9,475.00
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
$2,209.00 / $5,717.00 / $12,989.00