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Hawaii rates for HCPCS Q4106

Dermagraft, per sq cm

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.29 / $37.29 / $38.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.46 / $44.94 / $44.94
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.24 / $66.59 / $76.73
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.00 / $70.00 / $70.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.20 / $47.68 / $76.41
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.25 / $39.72 / $41.39