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Hawaii rates for HCPCS A2011

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.18 / $87.10 / $125.89
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
$114.82 / $125.89 / $190.55