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Montana rates for HCPCS 15769

Grafting of autologous soft tissue, other, harvested by direct excision (eg, fat, dermis, fascia)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$429.81 / $446.98 / $2,284.38
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47,000.00 / $77,999.99 / $94,999.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$761.36 / $761.36 / $761.36
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$761.36 / $761.36 / $761.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$614.27 / $761.36 / $761.36
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$424.18 / $471.05 / $753.68
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.75 / $686.70 / $931.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$748.44 / $817.74 / $890.86