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Hawaii rates for HCPCS Q4108

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.54 / $38.54 / $38.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.54 / $53.81 / $53.81
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.64 / $68.55 / $77.25
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.40 / $46.25 / $53.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.54 / $48.43 / $57.81