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Illinois rates for HCPCS 15769

Grafting Of Autologous Soft Tiss By Direct Exc

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$456.65 / $2,747.00 / $7,407.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.47 / $446.98 / $936.46
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,170.99 / $5,416.88 / $9,702.98
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.47 / $693.47 / $838.71
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$875.00 / $875.00 / $908.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$470.85 / $649.04 / $942.25
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$485.69 / $804.82 / $2,755.07
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
$566.57 / $608.70 / $675.01
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $32.34 / $778.86
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,600.00 / $5,000.00 / $8,995.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$438.26 / $636.86 / $1,041.97