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Idaho 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
$860.20 / $5,519.00 / $15,650.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$431.22 / $617.79 / $765.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$310.70 / $661.10 / $840.56
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$354.97 / $659.06 / $790.78
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$778.70 / $849.49 / $943.88
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $32.34 / $753.32
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,793.45 / $8,854.77 / $10,870.07
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$734.14 / $740.65 / $892.36
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,360.00 / $16,762.00 / $17,870.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$485.10 / $623.70 / $831.60