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Oklahoma rates for HCPCS 15115

Epidermal autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 100 sq cm or less, or 1% of body area of infants and children

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$838.00 / $3,165.00 / $8,400.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$682.29 / $781.37 / $814.51
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,374.38 / $8,476.95 / $13,489.91
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$665.70 / $895.08 / $1,065.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$736.22 / $937.80 / $1,129.47
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$693.19 / $959.59 / $4,012.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$700.65 / $892.65 / $6,003.04
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$715.14 / $2,268.00 / $4,012.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$659.43 / $824.29 / $1,211.81