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Hawaii rates for HCPCS Q4150

AlloWrap DS or dry, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $77.62 / $85.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.18 / $77.62 / $104.71
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.65 / $125.89 / $144.54
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.54 / $173.78 / $218.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $104.71 / $125.89