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Hawaii rates for HCPCS Q4194

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $660.69 / $724.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $660.69 / $1,023.29
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $977.24 / $1,071.52
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.54 / $173.78 / $218.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $645.65 / $1,000.00