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Louisiana 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
$891.25 / $2,691.53 / $5,370.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.42 / $489.78 / $724.44
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.98 / $194.98 / $194.98
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,630.78 / $6,760.83 / $13,803.84
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $537.03 / $588.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $562.34 / $794.33
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,023.29 / $3,467.37 / $8,511.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.38 / $501.19 / $776.25