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Nebraska 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
$4,241.22 / $10,431.19 / $21,899.37
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,766.83 / $15,476.59 / $29,936.73
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21,136.59 / $21,136.59 / $21,136.59
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$942.59 / $1,649.53 / $9,696.00
Medica
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$262.95 / $7,575.71 / $7,575.71
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,681.70 / $2,561.71 / $27,268.38
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,777.00 / $8,220.00 / $9,696.00