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Hawaii rates for HCPCS 40845

Vestibuloplasty; complex (including ridge extension, muscle repositioning)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,861.43 / $2,747.00 / $6,084.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,166.59 / $1,272.39 / $1,480.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,466.19 / $1,718.32 / $1,886.28
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,884.81 / $2,168.62 / $2,405.76
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,330.00 / $1,692.73 / $2,112.63
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,912.00 / $2,912.00 / $2,912.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,539.20 / $1,886.28 / $2,391.96
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,375.05 / $3,520.00 / $9,057.00