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Montana 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
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$380.19 / $380.19 / $380.19
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$407.38 / $416.87 / $446.68
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$213.80 / $295.12 / $537.03