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Hawaii rates for HCPCS Q4180

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$656.12 / $656.12 / $662.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$219.29 / $656.12 / $656.12
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$773.78 / $889.40 / $1,022.81
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$721.74 / $787.35 / $918.57
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$155.33 / $656.12 / $1,608.09