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Hawaii rates for HCPCS 69604

Revision mastoidectomy; resulting in tympanoplasty

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,583.13 / $3,107.00 / $8,431.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$961.08 / $1,058.51 / $1,058.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,127.16 / $1,412.98 / $1,412.98
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,518.55 / $1,747.23 / $4,334.00
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,243.42 / $1,356.46 / $1,582.53
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
$1,152.99 / $1,412.98 / $1,796.54
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,388.09 / $5,316.74 / $11,157.30