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Missouri rates for HCPCS 21705

Division of scalenus anticus; with resection of cervical rib

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,704.00 / $5,144.00 / $9,823.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.30 / $535.19 / $1,091.79
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,224.00 / $4,490.00 / $14,717.03
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$545.70 / $733.37 / $1,081.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$528.39 / $760.43 / $1,240.19
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$446.30 / $867.57 / $4,253.41
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$560.83 / $800.24 / $5,626.96
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,209.00 / $4,432.00 / $12,989.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$504.75 / $714.88 / $1,114.19