go back

Texas 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
$488.00 / $2,236.00 / $7,513.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,845.00 / $5,646.00 / $8,585.00
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.00 / $209.62 / $220.42
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$275.48 / $275.48 / $275.48
Cigna
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$27.03 / $27.03 / $27.03
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $55.00 / $3,764.32
Lucent Health
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$52.15 / $109.91 / $114.09
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$215.90 / $269.97 / $496.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$215.90 / $270.70 / $538.38
Providence
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$27.03 / $27.03 / $78.41
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$161.00 / $950.00 / $2,405.00