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Wisconsin 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 / $257.04 / $14,454.40
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,754.40 / $12,589.25 / $16,218.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$323.59 / $380.19 / $616.60
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$125.89 / $257.04 / $5,754.40
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.82 / $263.03 / $1,778.28
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.97 / $275.42 / $416.87
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$323.59 / $4,073.80 / $4,073.80
Quartz
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$32.36 / $32.36 / $83.18
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,023.29 / $1,584.89 / $2,137.96