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Kentucky 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
$378.00 / $563.77 / $9,311.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$399.81 / $454.33 / $625.26
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,643.00 / $3,428.00 / $8,517.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$314.07 / $380.54 / $483.69
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$450.74 / $548.85 / $640.77
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$431.97 / $618.66 / $883.82
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$542.73 / $542.73 / $542.73
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$409.28 / $560.89 / $922.75
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $32.34 / $574.48
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$739.00 / $2,194.00 / $8,174.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$400.84 / $551.49 / $793.13