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Wisconsin rates for HCPCS 21720

Division Sternocleidomastoid Open W/O Cast

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$497.59 / $1,058.49 / $14,482.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$452.25 / $575.62 / $2,184.38
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,060.00 / $7,344.00 / $10,517.23
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$475.09 / $1,148.28 / $3,157.61
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,462.54 / $3,462.54 / $3,462.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,339.97 / $1,565.86 / $2,402.06
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$607.96 / $1,975.85 / $2,327.54
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$497.59 / $696.63 / $1,058.49
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.64 / $987.91 / $8,296.28
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$484.66 / $957.18 / $3,855.60
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.60 / $332.64 / $1,054.42
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$497.59 / $675.56 / $1,058.49
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,072.50 / $1,306.80 / $1,946.05
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,244.77 / $3,244.77 / $8,957.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$958.28 / $2,381.05 / $3,855.60
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,636.66 / $1,636.66 / $1,636.66
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.19 / $2,513.14 / $3,259.65
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,103.00 / $6,477.00 / $8,384.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$508.24 / $971.47 / $2,166.76