go back

Hawaii rates for HCPCS Q4164

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,640.93 / $1,640.93 / $1,657.34
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,640.93 / $1,640.93 / $1,640.93
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,681.09 / $1,932.29 / $2,222.13
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,805.02 / $1,969.11 / $2,297.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,503.96 / $1,640.93 / $2,461.40