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Hawaii rates for HCPCS 19367

Breast Reconstruction Single Pedicled Tram Flap

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,747.00 / $2,747.00 / $2,747.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,337.40 / $1,628.80 / $1,628.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,785.77 / $2,206.36 / $2,206.36
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,395.21 / $2,817.90 / $3,175.50
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,941.60 / $2,118.11 / $2,471.13
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,912.00 / $2,912.00 / $2,912.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,800.39 / $2,206.36 / $2,859.53
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.27 / $1,587.32 / $2,222.23