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California rates for HCPCS 22869

Insertion of interlaminar/interspinous process stabilization/distraction device, without open decompression or fusion, including image guidance when performed, lumbar; single level

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,919.00 / $6,159.00 / $17,030.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,908.00 / $9,596.00 / $18,812.00
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.00 / $100.00 / $6,806.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19,468.00 / $21,361.83 / $38,260.00
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$468.35 / $500.78 / $15,250.84
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$411.28 / $568.92 / $1,025.39
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $3,579.30 / $61,697.35
Lucent Health
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$100.13 / $5,848.03 / $5,848.03
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$450.73 / $559.49 / $765.02
Providence
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$48.50 / $48.50 / $140.01
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,212.00 / $13,784.00 / $29,312.00