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South Carolina 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
$1,445.44 / $9,120.11 / $16,595.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.63 / $562.34 / $1,096.48
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.55 / $354.81 / $812.83
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $602.56 / $912.01
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$575.44 / $891.25 / $933.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $676.08 / $1,202.26
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $870.96 / $1,258.93
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$537.03 / $707.95 / $1,174.90
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $33.11
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,096.48 / $3,890.45 / $7,762.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.68 / $562.34 / $912.01