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Hawaii rates for HCPCS Q4115

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.86 / $12.86 / $12.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.86 / $15.45 / $18.18
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.84 / $23.16 / $26.10
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.15 / $15.43 / $18.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.86 / $18.18 / $19.29
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.86 / $11.74 / $19.54