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Hawaii rates for HCPCS 65125

Modification of ocular implant with placement or replacement of pegs (eg, drilling receptacle for prosthesis appendage) (separate procedure)

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
$288.40 / $446.68 / $741.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $512.86 / $602.56
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $602.56 / $4,677.35
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.00 / $537.03 / $645.65
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,995.26 / $1,995.26 / $1,995.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $524.81 / $776.25
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.18 / $407.38 / $660.69