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Montana rates for HCPCS 21720

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $630.96 / $1,318.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$851.14 / $851.14 / $851.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $676.08 / $851.14
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$851.14 / $933.25 / $1,071.52
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $933.25 / $1,071.52
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$575.44 / $676.08 / $1,047.13
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $707.95 / $1,096.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $831.76 / $1,000.00