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Hawaii rates for HCPCS 21700

Division of scalenus anticus; without resection of cervical rib

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,157.88 / $2,747.00 / $3,883.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$441.22 / $441.22 / $514.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$329.08 / $420.60 / $504.72
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$522.50 / $587.04 / $2,077.00
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$370.13 / $403.78 / $471.07
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,981.00 / $1,981.00 / $1,981.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$343.21 / $420.60 / $553.58
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$413.63 / $1,958.52 / $5,287.00