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Hawaii rates for HCPCS 15220

Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 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 / $660.69 / $1,096.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $812.83 / $1,000.00
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,230.27 / $7,413.10
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $912.01 / $1,071.52
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
$588.84 / $870.96 / $1,258.93
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $2,041.74 / $5,370.32