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Pennsylvania 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
$1,047.13 / $3,981.07 / $8,317.64
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20,417.38 / $21,379.62 / $57,543.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$724.44 / $724.44 / $724.44
Cigna
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$72.44 / $72.44 / $72.44
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47,863.01 / $47,863.01 / $47,863.01
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$954.99 / $2,818.38 / $8,317.64
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$891.25 / $891.25 / $891.25
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.87 / $416.87 / $602.56
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,454.71 / $5,495.41 / $39,810.72