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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
$537.03 / $758.58 / $1,445.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$870.96 / $870.96 / $870.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $741.31 / $912.01
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$812.83 / $933.25 / $1,122.02
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $933.25 / $1,122.02
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$562.34 / $758.58 / $1,071.52
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $741.31 / $1,122.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $891.25 / $1,023.29