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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
$125.49 / $259.72 / $14,482.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,159.00 / $11,302.00 / $14,586.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$327.11 / $382.25 / $586.38
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$125.49 / $188.24 / $293.70
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$127.16 / $252.11 / $1,756.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$125.49 / $188.24 / $293.70
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$259.19 / $316.01 / $471.74
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,272.08 / $4,272.08 / $4,272.08
Quartz
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$60.40 / $60.40 / $60.40
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,034.00 / $1,423.00 / $2,202.90