go back

Oklahoma rates for HCPCS 15277

Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area greater than or equal to 100 sq cm; first 100 sq cm wound surface area, or 1% of body area of infants and children

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$838.00 / $3,165.00 / $8,400.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$185.15 / $263.72 / $350.59
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
$217.35 / $298.45 / $443.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$230.33 / $317.86 / $460.66
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$226.91 / $382.01 / $3,390.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$293.26 / $361.38 / $1,622.24
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
$282.66 / $353.32 / $512.10