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Montana rates for HCPCS 15769

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

Facilitymedian $832 · 10th–90th $589–$10,0000%50%10th90th$832Professionalmedian $661 · 10th–90th $245–$1,8200%20%10th90th$661$1.0$10.0$100.0$1.0K$10.0K$100.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.89 / $0.89 / $0.89
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$245.47 / $616.60 / $1,819.70
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$46,773.51 / $75,857.76 / $95,499.26
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$645.65 / $645.65 / $758.58
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$758.58 / $758.58 / $758.58
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$616.60 / $616.60 / $758.58
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$794.33 / $831.76 / $891.25
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$794.33 / $831.76 / $891.25
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$416.87 / $501.19 / $758.58
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $501.19 / $912.01
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$588.84 / $588.84 / $588.84
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$676.08 / $812.83 / $891.25