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Hawaii rates for HCPCS Q4116

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30,720.00 / $30,720.00 / $30,720.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.82 / $25.82 / $3,374.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.11 / $31.11 / $31.11
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.37 / $34.90 / $38.34
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.58 / $56.58 / $56.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.09 / $31.11 / $46.67
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.24 / $37.24 / $38.79