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Oklahoma rates for HCPCS 15130

Dermal autograft, trunk, arms, legs; 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
$509.83 / $616.14 / $723.97
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,878.46 / $6,117.46 / $9,735.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$577.04 / $793.24 / $965.68
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$608.38 / $824.71 / $4,830.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$598.55 / $744.53 / $5,312.80
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$884.00 / $2,988.53 / $5,543.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$595.62 / $722.19 / $1,079.09