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Oklahoma rates for HCPCS 15100

Split-thickness autograft, trunk, arms, legs; first 100 sq cm or less, or 1% of body area of infants and children (except 15050)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$949.35 / $2,827.00 / $8,400.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$646.99 / $785.29 / $1,011.27
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,374.38 / $8,537.98 / $13,565.01
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$695.17 / $934.29 / $1,135.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$740.36 / $958.84 / $1,184.21
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$671.12 / $994.34 / $3,790.62
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$744.07 / $941.29 / $6,396.72
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$575.00 / $1,928.00 / $4,083.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$717.18 / $896.47 / $1,299.33