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Oklahoma rates for HCPCS 15241

Full thickness graft, free, including direct closure of donor site, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, and/or feet; 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
$957.00 / $3,684.00 / $12,600.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.81 / $169.61 / $174.18
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
$102.20 / $168.35 / $246.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$113.41 / $162.78 / $242.34
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$105.95 / $181.17 / $1,582.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$155.16 / $196.29 / $1,925.20
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
$149.55 / $186.94 / $267.27