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South Dakota rates for HCPCS 22103

Partial excision of posterior vertebral component (eg, spinous process, lamina or facet) for intrinsic bony lesion, single vertebral segment; each additional segment (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$125.89 / $3,548.13 / $4,365.16
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.82 / $218.78 / $371.54
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $309.03 / $309.03
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.82 / $223.87 / $275.42
Sanford Health Plan
Facility/Professional
Professional
Modifier
AS
Low / Median / High Price
$53.70 / $53.70 / $53.70
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$812.83 / $812.83 / $812.83