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Virginia 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
$518.79 / $3,912.00 / $8,920.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,524.00 / $22,312.00 / $37,718.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$491.30 / $491.30 / $640.00
Cigna
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$48.50 / $48.50 / $48.50
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$413.22 / $517.45 / $611.53
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$451.15 / $632.40 / $858.96
Medcost
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$81.59 / $103.48 / $168.33
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$458.94 / $673.88 / $2,100.89
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,408.00 / $13,296.00 / $26,537.00