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Wisconsin rates for HCPCS 21705

Division of scalenus anticus; with resection of cervical rib

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$489.78 / $1,023.29 / $14,454.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.63 / $562.34 / $1,621.81
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,019.95 / $4,786.30 / $7,413.10
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $954.99 / $2,511.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,288.25 / $1,513.56 / $2,398.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $2,041.74 / $2,344.23
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.19 / $1,096.48 / $5,754.40
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $1,202.26 / $1,548.82
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$512.86 / $1,096.48 / $15,135.61
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $1,000.00 / $5,623.41
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $70.79
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $1,174.90 / $1,819.70
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,288.25 / $4,168.69 / $4,168.69
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $2,570.40 / $5,623.41
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,659.59 / $1,659.59 / $1,659.59
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,737.80 / $2,818.38 / $3,162.28
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,912.51 / $13,803.84 / $17,782.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $831.76 / $2,089.30