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New Hampshire 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
$100.00 / $1,776.79 / $9,859.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,334.70 / $11,483.00 / $21,862.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,217.95 / $1,217.95 / $1,217.95
Cigna
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$121.06 / $121.06 / $121.06
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,399.00 / $12,399.00 / $12,399.00