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Oklahoma rates for HCPCS 15131

Dermal autograft, trunk, arms, legs; each additional 100 sq cm, or each additional 1% of body area of infants and children, or part thereof (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.19 / $2,398.83 / $6,606.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.13 / $89.13 / $158.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $123.03 / $144.54
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.13 / $128.82 / $1,862.09
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $107.15 / $758.58
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.04 / $707.95 / $1,659.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $93.33 / $128.82