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Pennsylvania rates for HCPCS 21700

Division of scalenus anticus; without resection of cervical rib

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$918.00 / $2,747.00 / $8,017.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$321.57 / $368.31 / $514.02
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,058.35 / $6,182.00 / $17,094.48
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.82 / $390.01 / $668.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$405.65 / $405.65 / $405.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$343.24 / $457.42 / $752.54
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$415.47 / $572.04 / $717.63
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$954.00 / $3,077.00 / $8,017.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$330.16 / $423.86 / $1,821.04
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$636.10 / $636.10 / $757.00
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$405.65 / $405.65 / $405.65
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$344.37 / $459.39 / $785.07
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$346.79 / $346.79 / $536.13
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.68 / $353.06 / $486.25
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,781.00 / $4,789.00 / $22,992.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$351.37 / $463.54 / $731.44