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Hawaii rates for HCPCS 15121

Split-thickness autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; 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
$1,778.28 / $4,466.84 / $4,466.84
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.25 / $234.42 / $295.12
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,071.52 / $1,071.52 / $1,071.52