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Hawaii rates for HCPCS Q4204

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,692.14 / $3,692.14 / $3,729.06
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,692.14 / $3,692.14 / $3,692.14
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,940.39 / $4,529.18 / $4,974.18
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,061.36 / $4,430.57 / $5,169.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,747.63 / $3,692.14 / $5,538.21