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Oklahoma rates for HCPCS 15221

Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$175.48 / $2,963.00 / $8,400.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.67 / $128.10 / $131.15
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,878.46 / $6,161.50 / $9,789.29
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.20 / $126.28 / $182.27
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.53 / $104.29 / $182.28
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.06 / $136.41 / $1,582.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.63 / $146.28 / $1,510.76
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$139.00 / $610.00 / $1,883.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.45 / $139.31 / $197.94