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Wisconsin rates for HCPCS 22853

Insertion of interbody biomechanical device(s) (eg, synthetic cage, mesh) with integral anterior instrumentation for device anchoring (eg, screws, flanges), when performed, to intervertebral disc space in conjunction with interbody arthrodesis, each interspace (List separately in addition to code for primary procedure)

Facilitymedian $955 · 10th–90th $240–$7,9430%10%10th90th$955Professionalmedian $479 · 10th–90th $59–$2,4550%5%10%10th90th$479$1.0$5.0$20.0$100.0$500.0$2.0K$10.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$234.42 / $954.99 / $7,943.28
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$239.88 / $676.08 / $2,754.23
Aetna
Facility/Professional
Professional
Modifier
AS
Typical Low / Median / Typical High
$25.70 / $72.44 / $575.44
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$239.88 / $457.09 / $1,202.26
Anthem BCBS
Facility/Professional
Professional
Modifier
AS
Typical Low / Median / Typical High
$33.11 / $64.57 / $169.82
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$295.12 / $316.23 / $426.58
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$616.60 / $724.44 / $1,148.15
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$338.84 / $1,023.29 / $1,148.15
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$239.88 / $549.54 / $10,471.29
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$426.58 / $575.44 / $741.31
DeanCare
Facility/Professional
Professional
Modifier
AS
Typical Low / Median / Typical High
$60.26 / $79.43 / $102.33
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$245.47 / $616.60 / $1,778.28
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$269.15 / $457.09 / $1,819.70
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $70.79
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$831.76 / $933.25 / $2,344.23
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$295.12 / $436.52 / $1,071.52
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$302.00 / $549.54 / $794.33
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$616.60 / $616.60 / $1,548.82
Quartz
Facility/Professional
Facility
Modifier
62
Typical Low / Median / Typical High
$389.05 / $389.05 / $977.24
Quartz
Facility/Professional
Facility
Modifier
AS
Typical Low / Median / Typical High
$61.66 / $61.66 / $154.88
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$426.58 / $1,174.90 / $1,778.28
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$776.25 / $776.25 / $776.25
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$691.83 / $1,348.96 / $1,513.56
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,023.29 / $1,584.89 / $2,187.76
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $691.83 / $1,659.59