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South Dakota 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
$542.39 / $542.39 / $3,511.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.53 / $542.39 / $1,306.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$949.22 / $1,235.65 / $1,544.57
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$700.41 / $892.74 / $1,407.46
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$510.48 / $1,103.40 / $4,241.68
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$660.80 / $1,089.00 / $1,338.32
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$810.16 / $1,043.47 / $1,459.88
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$668.04 / $917.78 / $1,079.68
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,643.00 / $1,643.00 / $1,643.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$507.72 / $972.05 / $1,485.71
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.09 / $1,310.50 / $1,310.50