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Maine 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
$1,862.09 / $3,715.35 / $7,585.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $446.68 / $1,071.52
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $645.65 / $912.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $660.69 / $1,071.52
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $660.69 / $1,000.00
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.91 / $3,090.30 / $7,585.78
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.19 / $489.78 / $1,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.63 / $676.08 / $1,000.00