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Hawaii rates for HCPCS Q4196

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.03 / $101.03 / $102.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.03 / $119.16 / $126.83
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.34 / $161.58 / $177.46
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.13 / $121.24 / $141.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.03 / $114.15 / $151.55
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.54 / $105.46 / $136.34