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Maryland 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
$0.98 / $4,570.88 / $7,762.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $512.86 / $1,905.46
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $512.86 / $602.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.11 / $524.81 / $831.76
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.63 / $537.03 / $1,023.29
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,023.29 / $1,023.29 / $2,238.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $524.81 / $933.25
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$426.58 / $501.19 / $741.31