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Illinois 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
$616.60 / $3,548.13 / $9,332.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $467.74 / $1,148.15
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $190.55 / $190.55
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,365.16 / $5,128.61 / $9,120.11
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $691.83 / $831.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.68 / $645.65 / $977.24
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $794.33 / $2,884.03
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $602.56 / $676.08
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $32.36 / $33.11
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,698.24 / $4,365.16 / $9,332.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.52 / $616.60 / $1,023.29