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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
$1,513.56 / $3,890.45 / $3,890.45
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,096.48 / $1,096.48 / $1,096.48
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $363.08 / $512.86
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,071.52 / $1,071.52 / $1,071.52