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Tennessee 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
$1,213.99 / $2,940.00 / $7,602.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,679.00 / $9,314.00 / $16,534.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $79,924.50 / $79,924.50
Lucent Health
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$262.95 / $7,575.71 / $7,575.71
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,098.00 / $8,273.00 / $12,407.00