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Hawaii rates for HCPCS 15841

Graft for facial nerve paralysis; free muscle graft (including obtaining graft)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,635.55 / $2,747.00 / $5,484.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,818.10 / $2,228.06 / $2,673.68
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,341.78 / $2,562.83 / $3,104.65
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,960.70 / $2,138.94 / $2,495.42
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
$1,818.10 / $2,228.06 / $4,727.70
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,368.05 / $4,057.27 / $8,007.00