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Arizona 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
$1,965.00 / $4,521.00 / $8,447.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$242.92 / $446.98 / $769.17
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$587.35 / $2,283.06 / $3,616.69
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$298.39 / $397.85 / $462.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$435.49 / $558.64 / $867.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$431.39 / $599.48 / $6,124.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$429.66 / $498.96 / $1,238.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,878.00 / $4,545.00 / $7,217.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$425.17 / $485.10 / $739.28