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Hawaii rates for HCPCS Q4102

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.88 / $11.88 / $12.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.88 / $12.31 / $14.48
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.33 / $17.62 / $20.26
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.07 / $14.26 / $16.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.88 / $14.48 / $17.82
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.72 / $13.21 / $15.57