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Illinois rates for HCPCS 21725

Division Sternocleidomastoid Open W/Cast

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$711.00 / $2,095.00 / $5,393.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$461.04 / $556.91 / $1,009.61
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$968.14 / $5,970.68 / $13,022.81
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$709.00 / $734.73 / $820.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$544.07 / $797.70 / $1,139.39
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$619.60 / $911.68 / $2,537.19
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.94 / $695.66 / $774.63
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $32.34 / $875.93
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$807.00 / $1,753.00 / $4,256.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$506.70 / $688.23 / $1,201.55