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Washington rates for HCPCS 21705

Division of scalenus anticus; with resection of cervical rib

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$951.00 / $5,132.00 / $22,024.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$509.95 / $713.71 / $1,541.30
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$724.35 / $18,220.34 / $35,644.43
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$745.58 / $1,161.70 / $5,626.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$714.97 / $765.00 / $870.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$573.91 / $948.82 / $1,567.14
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$575.55 / $1,070.73 / $1,446.37
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$520.79 / $1,031.60 / $1,407.15
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.55 / $390.48 / $1,047.78
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$771.81 / $1,004.28 / $1,074.40
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$715.74 / $715.74 / $724.35
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$809.75 / $1,169.20 / $1,437.75
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,233.34 / $18,633.84 / $35,644.43
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$729.96 / $1,031.01 / $1,375.97
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,028.00 / $5,547.00 / $19,271.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$661.92 / $901.32 / $1,535.74
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$439.22 / $439.22 / $542.09