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Hawaii rates for HCPCS 20805

Replantation, forearm (includes radius and ulna to radial carpal joint), complete amputation

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
$3,042.03 / $3,042.03 / $3,042.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,118.37 / $4,004.34 / $4,805.21
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,565.72 / $5,129.74 / $5,899.20
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,523.82 / $3,844.16 / $4,484.85
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,340.00 / $3,340.00 / $3,340.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,267.54 / $4,004.34 / $5,203.77
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.27 / $3,309.28 / $4,355.10