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Hawaii rates for HCPCS Q4253

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.79 / $75.79 / $76.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.79 / $143.31 / $143.31
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$156.93 / $174.37 / $200.53
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.37 / $90.95 / $106.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.79 / $113.69 / $143.31