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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
Facility
Modifier
Low / Median / High Price
$0.89 / $0.89 / $0.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $588.84 / $1,819.70
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46,773.51 / $81,283.05 / $95,499.26
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $645.65 / $758.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$758.58 / $758.58 / $758.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $758.58 / $812.83
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$794.33 / $831.76 / $891.25
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $831.76 / $891.25
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.87 / $524.81 / $758.58
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $616.60 / $933.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $812.83 / $891.25