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Alaska rates for HCPCS 15769

Grafting of autologous soft tissue, other, harvested by direct excision (eg, fat, dermis, fascia)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,236.00 / $9,577.00 / $14,552.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$431.22 / $491.67 / $2,319.92
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$827.89 / $827.89 / $1,581.29
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,319.92 / $3,247.90 / $3,317.50
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,061.86 / $1,264.80 / $1,415.82
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,108.80 / $1,954.80 / $2,115.55
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,319.92 / $3,247.90 / $3,317.50
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$658.35 / $1,453.91 / $3,167.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$735.42 / $1,265.04 / $1,265.30