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Pennsylvania 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
$831.76 / $2,691.53 / $8,317.64
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,011.87 / $8,511.38 / $77,624.71
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$407.38 / $407.38 / $407.38
Cigna
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$40.74 / $40.74 / $40.74
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$660.69 / $2,344.23 / $8,317.64
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$478.63 / $478.63 / $478.63
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$239.88 / $275.42 / $275.42
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$162.18 / $1,071.52 / $4,265.80