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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
$1,992.00 / $7,980.00 / $18,119.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$242.92 / $446.98 / $1,228.54
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,388.00 / $8,823.00 / $17,774.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$413.20 / $515.17 / $1,034.91
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.09 / $100.00 / $20,013.65
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$373.05 / $538.58 / $1,254.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.41 / $591.66 / $1,371.22
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$424.05 / $559.09 / $754.77
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$445.76 / $613.36 / $1,112.00
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $55.00 / $11,102.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,475.60 / $3,547.36 / $4,110.83
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $32.34 / $32.34
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$431.39 / $588.83 / $763.81
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$472.97 / $615.19 / $1,276.07
Sutter Health Plus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,156.00 / $5,156.00 / $5,156.00
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,569.35 / $1,569.35 / $1,569.35
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$451.30 / $593.66 / $720.88
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,670.00 / $9,810.00 / $21,278.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$375.15 / $512.82 / $1,394.11