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Hawaii rates for HCPCS 15201

Full thickness graft, free, including direct closure of donor site, trunk; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,157.88 / $2,747.00 / $3,883.00
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.87 / $157.43 / $186.06
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,078.00 / $1,078.00 / $1,078.00