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Michigan 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
$695.70 / $4,112.00 / $4,933.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.00 / $695.70 / $722.46
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$584.27 / $685.76 / $929.10
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$157.15 / $789.57 / $1,433.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$400.60 / $635.54 / $1,155.15
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$497.22 / $4,112.00 / $4,933.00
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$497.22 / $571.79 / $867.66
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.50 / $382.90 / $619.99
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$645.00 / $3,005.00 / $4,504.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$514.79 / $633.16 / $885.87