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North Carolina 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
$426.51 / $901.00 / $7,439.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16,405.75 / $16,405.75 / $23,441.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$606.10 / $606.10 / $18,668.89
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$426.51 / $739.17 / $844.54
Medcost
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$101.24 / $103.48 / $140.91
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,015.00 / $15,545.00 / $22,780.00
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $53,851.54 / $61,697.35
Wellcare
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$100.13 / $3,515.89 / $5,848.03