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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
$396.73 / $3,532.25 / $14,063.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$396.73 / $431.22 / $547.40
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,614.00 / $7,572.00 / $18,942.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$358.16 / $447.70 / $603.14
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$387.75 / $564.79 / $608.23
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$434.45 / $521.34 / $618.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,623.15 / $2,623.15 / $2,623.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$419.02 / $558.64 / $761.10
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,932.00 / $8,025.00 / $11,038.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$388.28 / $527.32 / $858.38