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Montana 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
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,707.27 / $1,707.27 / $1,707.27
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$833.85 / $911.52 / $1,707.27