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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
$851.14 / $5,495.41 / $8,709.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $537.03 / $1,148.15
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,513.56 / $6,760.83 / $11,220.18
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $870.96 / $933.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.63 / $660.69 / $831.76
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$467.74 / $794.33 / $7,079.46
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $812.83 / $912.01
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $32.36 / $33.11
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,456.54 / $8,128.31 / $11,220.18
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $891.25 / $1,000.00
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $426.58 / $8,511.38
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,332.54 / $16,982.44 / $18,197.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $645.65 / $870.96