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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
$893.00 / $2,678.00 / $7,602.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$461.59 / $557.03 / $867.66
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$778.00 / $1,522.00 / $2,430.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$509.17 / $690.39 / $1,092.28
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$548.16 / $738.03 / $1,120.50
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,074.76 / $3,776.52 / $26,542.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,241.68 / $4,241.68 / $4,719.68
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$719.00 / $1,560.00 / $2,914.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.55 / $614.28 / $1,132.93