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Wisconsin rates for HCPCS 21700

Division Scalenus Anticus W/O Rescj Cervical Rib

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$330.16 / $691.83 / $14,482.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$326.63 / $375.03 / $1,395.53
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,060.00 / $7,344.00 / $10,517.23
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$332.39 / $727.41 / $2,056.17
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,462.54 / $3,462.54 / $3,462.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$865.08 / $1,010.91 / $1,550.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$540.02 / $1,336.81 / $1,529.95
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$330.16 / $495.24 / $858.42
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$335.33 / $699.94 / $8,384.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$400.76 / $747.61 / $4,674.28
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.30 / $229.49 / $660.33
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$330.16 / $491.97 / $858.42
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$693.55 / $845.06 / $1,261.51
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,213.88 / $7,213.88 / $19,913.50
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$629.89 / $1,732.36 / $4,674.28
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,102.90 / $1,102.90 / $1,102.90
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.19 / $1,792.17 / $2,142.65
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,103.00 / $6,477.00 / $8,384.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.72 / $707.70 / $1,594.33