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Arizona rates for HCPCS 21705

Division of scalenus anticus; with resection of cervical rib

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,965.00 / $4,521.00 / $7,960.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$475.23 / $534.70 / $1,359.22
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,763.75 / $6,640.00 / $10,860.55
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$542.20 / $619.66 / $774.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$497.20 / $678.45 / $1,098.56
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$500.24 / $725.35 / $8,317.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$497.28 / $647.50 / $5,626.96
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,255.00 / $7,205.00 / $11,396.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$488.90 / $601.20 / $1,087.80