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Wisconsin rates for HCPCS 23455

Capsulorrhaphy Anterior W/Labral Repair

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$956.35 / $1,980.88 / $14,482.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,878.00 / $14,586.00 / $21,869.00
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,560.77 / $7,560.77 / $7,560.77
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,531.25 / $2,957.96 / $4,537.59
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$956.35 / $1,434.53 / $2,200.98
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$956.35 / $1,980.88 / $15,090.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$956.35 / $1,434.53 / $2,200.98
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,922.70 / $2,342.73 / $3,497.24
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,229.24 / $9,229.24 / $25,476.75
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,154.00 / $11,891.00 / $15,090.00