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Missouri 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
$619.37 / $4,908.00 / $12,237.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$243.45 / $431.22 / $1,088.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,088.00 / $4,279.00 / $10,011.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$397.31 / $503.91 / $860.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$420.28 / $637.02 / $1,073.17
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $709.36 / $6,944.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$413.15 / $575.23 / $3,547.36
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,708.00 / $3,502.00 / $6,944.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$403.82 / $552.38 / $914.73