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Hawaii rates for HCPCS 30920

Ligation arteries; internal maxillary artery, transantral

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,778.28 / $4,466.84 / $4,466.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $954.99 / $1,318.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $977.24 / $1,096.48
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,230.27 / $1,584.89 / $7,943.28
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $954.99 / $1,202.26
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,137.96 / $2,137.96 / $2,137.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $1,023.29 / $1,380.38
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $3,235.94 / $6,165.95