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Hawaii rates for HCPCS 15101

Split-thickness autograft, trunk, arms, legs; each additional 100 sq cm, or each additional 1% of body area of infants and children, or part thereof (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,324.03 / $2,747.00 / $4,456.00
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$126.63 / $200.00 / $236.81
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,078.00 / $1,078.00 / $1,078.00