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Indiana 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
$724.44 / $4,897.79 / $13,182.57
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $446.68 / $1,023.29
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $323.59 / $1,479.11
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,715.35 / $13,803.84 / $19,054.61
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.54 / $446.68 / $724.44
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$478.63 / $478.63 / $489.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$478.63 / $676.08 / $758.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.42 / $537.03 / $707.95
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,090.30 / $7,762.47 / $10,964.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $501.19 / $794.33