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Hawaii rates for HCPCS 21047

Excision of benign tumor or cyst of mandible; requiring extra-oral osteotomy and partial mandibulectomy (eg, locally aggressive or destructive lesion[s])

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,157.88 / $2,747.00 / $3,883.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,141.32 / $1,141.32 / $1,141.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,187.34 / $1,526.65 / $1,831.98
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,655.13 / $1,859.59 / $8,430.00
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,343.45 / $1,465.58 / $1,709.85
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
$1,245.75 / $1,526.65 / $2,065.89
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,125.68 / $2,220.92 / $5,304.00