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Texas 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
$655.92 / $2,747.00 / $7,542.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,948.65 / $18,922.13 / $39,391.35
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.00 / $387.56 / $389.52
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$491.30 / $491.30 / $491.30
Cigna
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$48.50 / $48.50 / $48.50
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $55.00 / $61,697.35
Lucent Health
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$100.13 / $5,848.03 / $5,848.03
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$392.42 / $485.15 / $886.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$392.70 / $491.94 / $1,010.41
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
$2,600.00 / $7,123.00 / $16,000.00