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Oklahoma rates for HCPCS 15276

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; each additional 25 sq cm wound surface area, or part thereof (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$625.00 / $2,652.00 / $7,500.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.26 / $29.74 / $33.24
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
$25.57 / $33.64 / $43.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.04 / $36.38 / $46.68
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.13 / $37.86 / $1,538.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.36 / $37.26 / $2,210.02
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $610.00 / $1,883.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.30 / $37.09 / $51.64