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Hawaii rates for HCPCS Q4107

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.94 / $83.94 / $85.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.96 / $85.96 / $86.57
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.06 / $108.96 / $117.58
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$159.16 / $159.16 / $159.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.57 / $127.74 / $204.71
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$116.21 / $116.21 / $121.05