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Pennsylvania 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
$1,123.06 / $4,048.00 / $8,451.00
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,531.00 / $27,840.00 / $46,296.00
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
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$114,978.42 / $114,978.42 / $114,978.42
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,123.06 / $4,993.00 / $10,247.00
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,217.95 / $1,217.95 / $1,217.95
Priority Health
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$121.06 / $121.06 / $121.06
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,053.47 / $1,053.47 / $1,100.25
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,468.00 / $4,563.00 / $9,631.00