22853

Insertion of cage or mesh device to spine bone and disc space during spine fusion

Medicare pricing data for 10,451 providers across 52 states

🤖AI Overview

This procedure has a 7.4x markup — hospitals charge $1,250 but Medicare allows only $169.35. Uninsured patients may face bills 7.4 times higher than what insurance negotiates. Note: These costs reflect the Medicare physician/supplier component. Hospital facility fees are billed separately and can be 2-5x the physician fee.

💡 What You Should Know

Insertion of cage or mesh device to spine bone and disc space during spine fusion (HCPCS code 22853) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $169.35, but hospitals typically charge $1,250 — a 7.4x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$33.87

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $169.35, your out-of-pocket cost would be approximately $33.87. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$169.35
Average Hospital Charge
$1,250
Markup Ratio
7.4x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$1,249.98
Medicare Allowed$169.35
Medicare Payment$135.21

Hospitals charge 7.4x more than what Medicare allows for this procedure. Medicare actually pays $135.21 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
District of Columbia$235$84928622+38.8%
Puerto Rico$217$53114210+28.3%
New York$210$2,7385426,668+23.9%
Massachusetts$199$1,7392043,789+17.6%
Pennsylvania$194$8893815,235+14.4%
Rhode Island$192$2,48442538+13.3%
Illinois$191$1,5723196,202+13.0%
Michigan$190$1,4063235,164+12.1%
Maryland$189$7932005,159+11.8%
California$182$1,21985317,413+7.7%
Vermont$182$1,0731064+7.6%
Florida$182$1,38584218,838+7.4%
Alaska$181$2,311401,178+6.9%
Kentucky$179$9131402,502+5.5%
New Mexico$176$1,09440678+4.1%
Hawaii$175$63118145+3.4%
Virginia$173$1,2202526,565+2.4%
Ohio$173$8373767,286+2.0%
Connecticut$172$1,8601811,730+1.7%
Montana$171$1,082521,341+0.9%
Texas$170$1,17579218,488+0.6%
New Jersey$169$5,2052853,294-0.2%
Georgia$167$1,2413197,227-1.3%
Missouri$165$1,1202154,729-2.9%
Maine$163$55339241-3.9%
Wyoming$163$1,78124416-3.9%
Tennessee$161$8542515,126-4.9%
Arizona$161$9492727,595-5.0%
Mississippi$160$1,361661,689-5.8%
Iowa$159$885881,294-5.8%
Arkansas$159$577751,909-6.0%
West Virginia$158$57543568-6.8%
Utah$157$7911222,520-7.3%
Oregon$157$7981492,552-7.5%
Colorado$156$8102597,772-8.0%
South Carolina$155$9171764,933-8.5%
North Carolina$154$8693738,207-8.9%
Nevada$154$2,2511112,180-9.0%
Louisiana$154$1,4931885,788-9.2%
Oklahoma$153$6741294,172-9.4%
Kansas$151$6141072,393-11.1%
Washington$150$6332824,834-11.5%
New Hampshire$149$2,56955667-11.8%
Minnesota$148$9821943,530-12.4%
Indiana$146$1,3322255,003-13.6%
Wisconsin$145$2,5121641,908-14.4%
North Dakota$143$732261,072-15.5%
Nebraska$141$773881,945-16.5%
Delaware$140$86939709-17.2%
Alabama$140$8941774,218-17.4%
Idaho$134$1,2361001,916-20.6%
South Dakota$127$600611,412-25.0%

⚠️ Important: These costs reflect the Medicare physician/supplier component. Hospital facility fees may be billed separately. Total out-of-pocket costs may be higher.

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