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Hawaii rates for HCPCS 15240

Full thickness graft, free, including direct closure of donor site, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, and/or feet; 20 sq cm or less

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,778.28 / $2,818.38 / $4,466.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $851.14 / $1,949.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $977.24 / $1,202.26
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,318.26 / $1,584.89 / $7,943.28
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $1,096.48 / $1,288.25
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
$724.44 / $1,023.29 / $1,513.56
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $2,691.53 / $6,165.95