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Hawaii rates for HCPCS 41250

Repair of laceration 2.5 cm or less; floor of mouth and/or anterior two-thirds of tongue

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,157.88 / $2,747.00 / $3,883.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,088.40 / $1,088.40 / $1,088.40
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$172.78 / $305.02 / $418.67
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,078.00 / $1,078.00 / $1,078.00