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Hawaii rates for HCPCS 15130

Dermal autograft, trunk, arms, legs; first 100 sq cm or less, or 1% of body area of infants and children

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,513.56 / $3,890.45 / $3,890.45
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $602.56 / $1,023.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $758.58 / $933.25
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.00 / $1,230.27 / $4,897.79
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $891.25 / $1,071.52
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,995.26 / $1,995.26 / $1,995.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $812.83 / $1,174.90
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $2,041.74 / $5,370.32