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Massachusetts 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
$691.83 / $3,388.44 / $5,623.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.04 / $501.19 / $1,380.38
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.23 / $4,570.88 / $11,220.18
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.19 / $676.08 / $1,513.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $660.69 / $1,148.15
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$457.09 / $1,000.00 / $7,079.46
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $616.60 / $870.96
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,137.96 / $5,248.07 / $11,220.18
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $831.76 / $1,412.54
Health New England
Facility/Professional
Facility
Modifier
Low / Median / High Price
$870.96 / $870.96 / $1,621.81
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.23 / $4,570.88 / $11,220.18
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.19 / $676.08 / $1,584.89
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,041.74 / $5,248.07 / $11,220.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $707.95 / $1,380.38