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Hawaii rates for HCPCS 21180

Reconstruction, entire or majority of forehead and/or supraorbital rims; with autograft (includes obtaining grafts)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,570.40 / $6,025.60 / $6,025.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,412.54 / $1,659.59 / $2,398.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,659.59 / $1,778.28 / $2,344.23
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,344.23 / $2,630.27 / $2,951.21
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,584.89 / $1,819.70 / $2,238.72
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,884.03 / $2,884.03 / $2,884.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.38 / $1,995.26 / $2,754.23
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.51 / $1,513.56 / $2,818.38