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Virginia 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
$159.55 / $5,087.00 / $8,920.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$152.81 / $152.81 / $1,700.00
Cigna
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$14.95 / $14.95 / $14.95
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.21 / $158.99 / $186.15
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$142.84 / $186.67 / $271.24
Medcost
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$24.90 / $30.10 / $51.15
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$132.38 / $187.47 / $677.68
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$231.00 / $1,045.00 / $2,364.00