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Oklahoma rates for HCPCS 15275

Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$160.77 / $2,657.00 / $7,236.46
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.90 / $137.75 / $160.77
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,950.44 / $6,161.50 / $9,663.96
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.34 / $151.90 / $208.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.57 / $146.94 / $225.25
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$94.91 / $175.18 / $3,390.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.19 / $168.30 / $3,179.06
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$575.00 / $1,928.00 / $3,790.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$129.34 / $169.76 / $237.66