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Hawaii rates for HCPCS Q4197

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.70 / $70.70 / $71.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.70 / $87.17 / $108.96
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.14 / $106.05 / $121.96
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.77 / $84.84 / $98.97
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.70 / $78.45 / $106.05