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Pennsylvania rates for HCPCS 21705

Division of scalenus anticus; with resection of cervical rib

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$759.34 / $4,048.00 / $10,247.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$482.29 / $551.41 / $925.61
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,531.00 / $27,840.00 / $46,296.00
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$530.35 / $586.19 / $1,001.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$607.54 / $607.54 / $607.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$513.03 / $685.64 / $1,125.35
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$619.08 / $853.51 / $1,069.32
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,043.03 / $9,043.03 / $10,836.65
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,020.00 / $4,993.00 / $10,247.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$491.12 / $600.14 / $2,660.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.10 / $776.10 / $1,119.90
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$607.54 / $607.54 / $607.54
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$513.03 / $688.33 / $1,174.31
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$518.60 / $518.60 / $653.15
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$495.04 / $528.97 / $653.15
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,468.00 / $4,563.00 / $9,631.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$522.52 / $691.17 / $1,100.86