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Hawaii rates for HCPCS Q4203

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,052.89 / $1,052.89 / $1,063.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$306.18 / $360.22 / $1,052.89
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$372.52 / $438.26 / $504.00
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,158.18 / $1,263.46 / $1,474.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$306.18 / $1,052.89 / $1,579.34