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Hawaii rates for HCPCS Q4101

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.23 / $30.23 / $30.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.23 / $33.46 / $36.57
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.94 / $46.60 / $51.18
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.25 / $36.28 / $42.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.23 / $32.90 / $45.35
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.36 / $37.07 / $39.32