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Hawaii rates for HCPCS 21081

Impression and custom preparation; mandibular resection prosthesis

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,462.08 / $1,462.08 / $1,724.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,619.71 / $1,984.94 / $2,381.92
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,911.90 / $2,154.29 / $2,412.17
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,335.05 / $1,746.75 / $1,984.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,619.71 / $1,984.94 / $2,611.46
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.74 / $1,453.04 / $2,093.46