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Hawaii rates for HCPCS Q4133

Grafix PRIME, GrafixPL PRIME, Stravix and StravixPL, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.74 / $138.74 / $140.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.74 / $144.13 / $166.50
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.92 / $212.13 / $228.92
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$152.61 / $166.49 / $194.24
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.74 / $149.85 / $208.11
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.13 / $161.13 / $178.99