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Oklahoma rates for HCPCS 15120

Split-thickness 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 (except 15050)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$851.14 / $1,778.28 / $6,606.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $741.31 / $1,445.44
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $549.54 / $549.54
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,128.61 / $7,943.28 / $12,882.50
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $912.01 / $1,096.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $954.99 / $1,202.26
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$724.44 / $1,047.13 / $6,165.95
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $954.99 / $6,309.57
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,230.27 / $4,265.80 / $8,317.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $794.33 / $1,071.52