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Hawaii rates for HCPCS 15572

Formation of direct or tubed pedicle, with or without transfer; scalp, arms, or legs

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,324.03 / $2,747.00 / $4,456.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$778.37 / $933.50 / $1,458.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$927.52 / $1,136.66 / $1,364.00
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,143.65 / $1,319.61 / $3,935.00
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$822.01 / $1,000.26 / $1,136.66
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,155.00 / $2,155.00 / $2,155.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$927.52 / $1,136.66 / $2,264.90
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$756.35 / $2,575.00 / $6,124.00