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Pennsylvania rates for HCPCS 22870

Insertion of interlaminar/interspinous process stabilization/distraction device, without open decompression or fusion, including image guidance when performed, lumbar; second level (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$641.00 / $2,371.00 / $7,629.00
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,000.00 / $8,639.91 / $79,506.39
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$134.09 / $134.09 / $134.09
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$641.00 / $2,326.00 / $8,017.00
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$134.09 / $134.09 / $134.09
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$115.45 / $115.45 / $161.51
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$162.00 / $650.00 / $3,742.00