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Arkansas 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
$831.76 / $1,819.70 / $2,454.71
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.08 / $489.78 / $1,071.52
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.98 / $194.98 / $288.40
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,311.31 / $3,311.31 / $4,570.88
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $467.74 / $616.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.12 / $512.86 / $724.44
Qualchoice
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.13 / $331.13 / $331.13
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,230.27 / $2,951.21 / $10,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.52 / $537.03 / $758.58