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Idaho rates for HCPCS 21725

Division of sternocleidomastoid for torticollis, open operation; with cast application

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,897.00 / $4,500.00 / $7,761.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$550.75 / $751.27 / $1,103.65
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$453.31 / $453.31 / $454.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$597.88 / $797.17 / $946.64
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$511.64 / $933.70 / $1,269.20
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$890.77 / $963.30 / $1,268.20
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $32.34 / $858.10
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$800.41 / $1,724.86 / $2,164.31
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$799.71 / $1,102.39 / $1,268.20
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$450.00 / $2,620.00 / $4,441.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$535.79 / $764.50 / $1,085.70