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Wisconsin rates for HCPCS 23655

Clsd Tx Shoulder Dislc W/Manipulation Req Anes

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$403.93 / $854.57 / $14,482.00
Aetna
Facility/Professional
Facility
Modifier
54
Low / Median / High Price
$302.95 / $302.95 / $1,142.28
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,905.00 / $3,496.00 / $5,962.00
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,942.50 / $1,942.50 / $1,942.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,089.45 / $1,273.10 / $1,952.99
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$379.81 / $501.50 / $949.53
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$379.81 / $816.59 / $5,261.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$379.81 / $501.50 / $949.53
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$824.85 / $1,005.05 / $1,500.34
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,722.47 / $1,722.47 / $4,754.80
Quartz
Facility/Professional
Facility
Modifier
54
Low / Median / High Price
$3,154.80 / $3,154.80 / $3,154.80
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,723.00 / $4,092.17 / $5,865.00