go back

Hawaii rates for HCPCS Q4201

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.09 / $76.09 / $76.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.09 / $102.04 / $127.55
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$105.52 / $124.14 / $142.76
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.70 / $91.31 / $106.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.09 / $102.04 / $114.14