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New Hampshire 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
$100.00 / $1,443.97 / $9,859.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$452.25 / $489.92 / $787.70
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,302.10 / $3,669.21 / $6,000.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$533.72 / $889.19 / $1,364.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$613.78 / $2,000.36 / $2,070.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$568.09 / $954.04 / $1,583.11
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$611.00 / $1,002.41 / $1,885.85
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,565.00 / $9,565.00 / $9,565.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.93 / $795.95 / $1,567.80
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$410.91 / $452.00 / $575.27