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Tennessee 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
$891.25 / $2,454.71 / $6,456.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.63 / $562.34 / $1,047.13
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$724.44 / $1,548.82 / $2,454.71
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $776.25 / $1,230.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.20 / $30.20 / $30.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $724.44 / $1,122.02
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,801.89 / $3,801.89 / $45,708.82
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,265.80 / $4,677.35 / $4,677.35
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$741.31 / $1,445.44 / $2,884.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.68 / $616.60 / $1,071.52