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Hawaii rates for HCPCS Q4221

Amnio Wrap2, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,961.00 / $1,961.00 / $1,980.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,961.00 / $1,961.00 / $1,961.00
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,135.08 / $2,454.11 / $2,822.23
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,157.10 / $2,353.19 / $2,745.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,928.16 / $1,961.00 / $2,941.50