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Hawaii rates for HCPCS 15131

Dermal 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
$1,000.00 / $2,884.03 / $2,884.03
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $85.11 / $134.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $100.00 / $120.23
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $138.04 / $169.82
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $114.82 / $144.54
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,071.52 / $1,071.52 / $1,071.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $117.49 / $158.49
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $1,548.82 / $3,981.07