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Hawaii rates for HCPCS 21720

Division of sternocleidomastoid for torticollis, open operation; without cast application

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,778.28 / $4,466.84 / $4,466.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $512.86 / $954.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $575.44 / $741.31
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $831.76 / $5,011.87
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $707.95 / $870.96
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,995.26 / $1,995.26 / $1,995.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.11 / $549.54 / $831.76
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $2,570.40 / $6,165.95