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Hawaii rates for HCPCS 39503

Repair, neonatal diaphragmatic hernia, with or without chest tube insertion and with or without creation of ventral hernia

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,818.38 / $2,818.38 / $2,818.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,370.32 / $5,754.40 / $6,456.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,025.60 / $6,606.93 / $7,244.36
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,585.78 / $8,317.64 / $10,000.00
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,623.41 / $6,165.95 / $7,585.78
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,454.71 / $2,454.71 / $2,454.71
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,495.41 / $6,760.83 / $9,120.11
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.51 / $6,918.31 / $8,912.51