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Massachusetts 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
$1,758.00 / $2,733.00 / $4,712.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.00 / $544.76 / $856.27
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$910.36 / $1,600.00 / $7,161.00
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$550.38 / $910.37 / $4,241.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$554.29 / $864.81 / $1,557.94
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$549.96 / $1,191.52 / $6,679.00
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$631.08 / $764.44 / $1,048.54
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$683.62 / $1,293.48 / $1,702.62
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,106.00 / $2,510.00 / $26,542.00
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$591.15 / $1,008.88 / $4,241.68
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,106.00 / $2,408.00 / $5,683.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$563.00 / $833.08 / $1,720.67