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Wisconsin rates for HCPCS 23350

Injection Shoulder Arthrography/ Ct/Mri Arthg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$165.58 / $540.53 / $2,812.39
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$1,399.46 / $1,399.46 / $1,399.46
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.07 / $165.58 / $689.33
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$353.85 / $353.85 / $862.32
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,139.00 / $1,183.00 / $1,530.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.53 / $136.49 / $334.02
Anthem BCBS
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$109.71 / $204.73 / $511.56
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.25 / $60.96 / $77.47
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$148.97 / $184.44 / $375.98
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$438.85 / $512.83 / $681.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.04 / $224.33 / $747.36
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$49.22 / $139.10 / $266.08
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$53.15 / $174.58 / $1,449.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.02 / $570.24 / $1,786.65
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.96 / $158.49 / $395.19
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$49.22 / $139.10 / $266.08
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.88 / $232.36 / $519.20
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$127.41 / $367.00 / $2,922.50
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.50 / $605.41 / $1,786.65
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.01 / $314.12 / $1,046.67
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,034.00 / $1,533.00 / $2,202.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.02 / $416.25 / $713.94