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Hawaii rates for HCPCS A6204

Composite dressing, sterile, pad size more than 16 sq in, but less than or equal to 48 sq in, with any size adhesive border, each dressing

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.42 / $2.54 / $4.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.45 / $11.28 / $11.28
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.25 / $10.73 / $10.73
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.35 / $14.35 / $14.35
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.89 / $9.58 / $12.78
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.99 / $8.53 / $9.76