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Arizona rates for HCPCS 22868

Insertion of interlaminar/interspinous process stabilization/distraction device, without fusion, including image guidance when performed, with open decompression, lumbar; second level (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,170.00 / $2,640.00 / $5,506.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$438.60 / $1,651.20 / $2,700.74
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$226.04 / $317.22 / $1,944.00
Medica
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$57.75 / $57.75 / $109.91
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$716.00 / $1,535.00 / $2,175.00