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Oklahoma rates for HCPCS 15278

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; each additional 100 sq cm wound surface area, or part thereof, or each additional 1% of body area of infants and children, or part thereof (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.19 / $2,398.83 / $6,606.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.77 / $74.13 / $128.82
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,630.78 / $5,754.40 / $9,332.54
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.70 / $74.13 / $123.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.88 / $85.11 / $125.89
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.54 / $102.33 / $1,584.89
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $97.72 / $6,025.60
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.04 / $630.96 / $1,659.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.29 / $77.62 / $114.82