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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
$2,747.00 / $2,747.00 / $2,747.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,429.54 / $5,429.54 / $5,897.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,053.69 / $6,668.01 / $7,207.47
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,556.39 / $8,489.83 / $10,018.00
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,867.85 / $6,401.29 / $7,468.17
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,446.00 / $2,446.00 / $2,446.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,441.10 / $6,753.44 / $9,123.06
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.27 / $6,884.31 / $8,842.15