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California 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
$3,467.37 / $9,772.37 / $19,054.61
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $489.78 / $1,995.26
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.09 / $229.09 / $229.09
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,025.60 / $10,471.29 / $17,782.79
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $575.44 / $1,513.56
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.07 / $5,011.87 / $22,387.21
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $630.96 / $1,445.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $588.84 / $1,230.27
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$426.58 / $524.81 / $707.95
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$426.58 / $575.44 / $977.24
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.95 / $56.23 / $11,220.18
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,467.37 / $4,073.80 / $4,073.80
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $691.83 / $691.83
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.87 / $549.54 / $758.58
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $588.84 / $1,258.93
Sutter Health Plus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,128.61 / $5,128.61 / $5,128.61
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,584.89 / $1,584.89 / $1,584.89
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$426.58 / $549.54 / $724.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,623.41 / $10,232.93 / $20,892.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.54 / $524.81 / $1,047.13