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Pennsylvania rates for HCPCS 23655

Closed treatment of shoulder dislocation, with manipulation; requiring anesthesia

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$430.95 / $1,896.99 / $6,432.00
Aetna
Facility/Professional
Facility
Modifier
54
Low / Median / High Price
$287.00 / $323.20 / $2,572.27
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,404.00 / $4,354.00 / $8,639.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$472.05 / $472.05 / $472.05
Cigna
Facility/Professional
Facility
Modifier
54
Low / Median / High Price
$328.83 / $328.83 / $328.83
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,466.80 / $3,380.47 / $6,890.98
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$617.00 / $1,978.00 / $7,197.00
Martin's Point
Facility/Professional
Facility
Modifier
54
Low / Median / High Price
$323.20 / $323.20 / $2,572.27
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$472.05 / $472.05 / $472.05
Priority Health
Facility/Professional
Facility
Modifier
54
Low / Median / High Price
$328.83 / $328.83 / $328.83
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$335.58 / $402.96 / $402.96
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,214.00 / $2,799.90 / $5,438.27