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Hawaii rates for HCPCS Q4249

AMNIPLY, for topical use only, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,969.89 / $1,969.89 / $1,989.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,969.89 / $1,969.89 / $1,969.89
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,091.66 / $2,404.21 / $2,640.42
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,166.88 / $2,363.86 / $2,757.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,969.89 / $2,170.14 / $2,954.84