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Hawaii rates for HCPCS 15150

Tissue cultured skin autograft, trunk, arms, legs; first 25 sq cm or less

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
$512.86 / $616.60 / $977.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $707.95 / $870.96
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $1,023.29 / $1,258.93
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $851.14 / $1,023.29
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,698.24 / $1,698.24 / $1,698.24
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $851.14 / $1,122.02
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $2,041.74 / $5,370.32