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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)

Professionalmedian $2 · 10th–90th $2–$130%50%90th$2$2.0$5.0$10.0$20.0$50.0$100.0$200.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.00 / $2.00 / $10.00
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$10.96 / $12.88 / $125.89
HMSA
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$11.48 / $12.88 / $15.14
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$144.54 / $173.78 / $218.78
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$10.47 / $125.89 / $125.89