go back

Hawaii rates for HCPCS Q4111

GammaGraft, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.87 / $7.87 / $7.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.47 / $7.87 / $8.78
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.08 / $11.20 / $12.88
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.66 / $9.44 / $11.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.47 / $7.91 / $11.81
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.06 / $8.76 / $9.46