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Pennsylvania rates for HCPCS 22857

Total disc arthroplasty (artificial disc), anterior approach, including discectomy to prepare interspace (other than for decompression); single interspace, lumbar

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,499.00 / $4,680.00 / $9,788.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,514.89 / $1,743.77 / $2,697.42
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,531.00 / $27,840.00 / $46,296.00
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,747.01 / $1,812.93 / $3,146.59
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,977.73 / $1,977.73 / $1,977.73
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,633.43 / $2,102.44 / $3,552.02
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,053.71 / $2,789.82 / $3,547.34
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,651.14 / $6,834.15 / $55,738.58
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,301.00 / $5,079.00 / $10,527.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,544.00 / $1,927.15 / $5,429.04
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,533.50 / $1,533.50 / $3,572.50
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,977.73 / $1,977.73 / $1,977.73
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,637.31 / $2,142.56 / $3,676.47
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,233.50 / $1,723.75 / $1,723.75
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,233.50 / $1,723.75 / $1,819.48
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,340.00 / $6,515.00 / $12,076.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,530.78 / $2,152.28 / $3,555.66