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Oklahoma rates for HCPCS 15200

Full thickness graft, free, including direct closure of donor site, trunk; 20 sq cm or less

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,000.00 / $3,684.00 / $12,600.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$604.79 / $750.33 / $837.75
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,878.46 / $6,117.46 / $9,735.10
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$637.00 / $874.69 / $1,205.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$685.01 / $914.88 / $1,122.59
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$673.26 / $942.00 / $5,145.24
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$716.80 / $876.58 / $6,214.80
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$875.00 / $2,900.00 / $5,543.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$690.90 / $863.62 / $1,251.73