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California rates for HCPCS 22103

Prtl Exc Pst Vrt Intrnsc B1y Les 1 Vrt Sgm Ea

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,169.00 / $6,640.00 / $17,701.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,100.00 / $5,863.00 / $11,400.00
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.90 / $100.00 / $15,276.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,340.00 / $4,340.00 / $4,340.00
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$118.76 / $140.44 / $189.59
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.12 / $165.76 / $306.16
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$325.51 / $3,145.91 / $4,272.08
Lucent Health
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$25.82 / $60.40 / $63.40
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.09 / $172.80 / $248.37
Providence
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$14.95 / $14.95 / $43.57
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$587.00 / $1,533.00 / $6,323.00