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Montana rates for HCPCS 21725

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$578.11 / $764.13 / $2,837.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$869.67 / $869.67 / $869.67
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$401.59 / $869.67 / $906.17
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$431.06 / $592.70 / $869.67
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$522.45 / $869.67 / $1,130.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$699.24 / $887.04 / $1,009.14