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Hawaii rates for HCPCS Q4195

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.72 / $97.72 / $107.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.07 / $97.72 / $112.20
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.04 / $158.49 / $173.78
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
$104.71 / $125.89 / $165.96