Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.
Original text from hospital filings
Clsd Tx Shoulder Dislc W/Manipulation Req Anes
Utica, NY
See all hospitals reporting CPT 23655 →Price type
MVHS, Inc.’s median price of $176 is 90% below the median hospital's median price ($1.8k), higher than 1% of the 2,214 hospitals reporting CPT 23655. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 12 payers, 36 plan rates. A facility fee, a professional fee, a per diem and a case rate are different bills, so each is listed on its own. Open a payer to see it across hospitals.
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| # | |||||||
|---|---|---|---|---|---|---|---|
| 1 | Excellus excellus bcbs medicaid hmo fee schedule · outpatient | $5 | $5 | — | — | — | $5 – $5 |
| 2 | Medical Mutual worker's compensation and no fault fee schedule · outpatient | $50 | $50 | — | — | — | $50 – $50 |
| 3 | UnitedHealthcare uhc medicare advantage percent of total billed charges · inpatientfrom % of charges | $103 | $103 | — | — | — | $103 – $103 |
| 4 | Humana humana military percent of total billed charges · inpatientfrom % of charges | $176 | $176 | — | — | — | $176 – $176 |
| 5 | Tricare humana military percent of total billed charges · inpatientfrom % of charges | $176 | $176 | — | — | — | $176 – $176 |
| 6 | Humana choicecare fee schedule · both | $195 | $195 | — | — | — | $195 – $195 |
| 7 | Humana humana medicare advantage fee schedule · both | $195 | $195 | — | — | — | $195 – $195 |
| 8 | Aetna aetna medicare advantage fee schedule · both | $199 | $199 | — | — | — | $199 – $199 |
| 9 | Medicare medicare fee schedule · both | $199 | $199 | — | — | — | $199 – $199 |
| 10 | WellCare wellcare fee schedule · both | $205 | $205 | — | — | — | $205 – $205 |
| 11 | UnitedHealthcare uhc empire plan fee schedule · outpatient | $208 | $208 | $198 | 95% | — | $10 – $406 |
| 12 | Cigna mvp hmo/ppo fee schedule · both | $274 | $274 | — | — | — | $274 – $274 |
| 13 | Blue Cross Blue Shield excellus bcbs federal fee schedule · both | $293 | $293 | — | — | — | $293 – $293 |
| 14 | Bcbs Ny excellus bcbs indemnity case rate · inpatient | $852 | $852 | — | — | — | $852 – $852 |
| 15 | Blue Cross Blue Shield excellus bcbs hmo/ppo case rate · both | $852 | $852 | — | — | — | $852 – $852 |
| 16 | Excellus excellus bcbs hmo/ppo case rate · both | $852 | $852 | — | — | — | $852 – $852 |
| 17 | Excellus excellus bcbs indemnity case rate · inpatient | $852 | $852 | — | — | — | $852 – $852 |
| 18 | Humana humana military other · outpatient | $1.8k | $1.8k | — | — | — | $1.8k – $1.8k |
| 19 | Tricare humana military other · outpatient | $1.8k | $1.8k | — | — | — | $1.8k – $1.8k |
| 20 | Excellus excellus bcbs medicare advantage other · outpatient | $2.0k | $2.0k | — | — | — | $2.0k – $2.0k |
| 21 | Humana humana medicare advantage other · outpatient | $2.0k | $2.0k | — | — | — | $2.0k – $2.0k |
| 22 | Medicare medicare other · outpatient | $2.0k | $2.0k | — | — | — | $2.0k – $2.0k |
| 23 | Optum vaccn optum other · outpatient | $2.0k | $2.0k | — | — | — | $2.0k – $2.0k |
| 24 | UnitedHealthcare uhc medicare advantage other · outpatient | $2.0k | $2.0k | — | — | — | $2.0k – $2.0k |
| 25 | Aetna aetna medicare advantage other · outpatient | $2.0k | $2.0k | — | — | — | $2.0k – $2.0k |
Last updated: Aug 7, 2026
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