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Hawaii rates for HCPCS Q4248

Dermacyte Amniotic Membrane Allograft, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $549.54 / $616.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $549.54 / $549.54
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,202.26 / $1,318.26 / $1,659.59
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.54 / $173.78 / $218.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $131.83 / $2,691.53