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Hawaii rates for HCPCS 15120

Split-thickness autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 100 sq cm or less, or 1% of body area of infants and children (except 15050)

Facilitymedian $3,890 · 10th–90th $1,514–$3,8900%50%10th$3,890Professionalmedian $1,023 · 10th–90th $617–$4,5710%10%10th90th$1,023$50.0$200.0$1.0K$5.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,513.56 / $3,890.45 / $3,890.45
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$602.56 / $870.96 / $1,819.70
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$891.25 / $1,071.52 / $1,288.25
HMSA
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,148.15 / $1,513.56 / $7,413.10
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$691.83 / $1,000.00 / $1,202.26
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,137.96 / $2,137.96 / $2,137.96
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$758.58 / $933.25 / $1,122.02
University Health Alliance
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$776.25 / $2,041.74 / $5,370.32