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Hawaii rates for HCPCS Q4126

MemoDerm, DermaSpan, TranZgraft or InteguPly, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.41 / $62.41 / $63.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.73 / $71.45 / $82.45
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.63 / $86.93 / $99.97
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.66 / $74.90 / $87.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.73 / $64.31 / $93.62