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Hawaii rates for HCPCS Q4124

OASIS ultra tri-layer wound matrix, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.49 / $2.49 / $2.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.49 / $12.02 / $12.26
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.98 / $14.92 / $16.86
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.73 / $2.98 / $3.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.49 / $3.74 / $12.26