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North Carolina 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
$466.38 / $4,729.50 / $7,968.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$400.80 / $466.39 / $765.64
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$508.91 / $569.94 / $1,161.73
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$503.30 / $663.42 / $1,210.44
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$451.45 / $617.79 / $664.93
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$664.93 / $664.93 / $664.93
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,366.00 / $9,541.00 / $14,589.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$403.71 / $495.55 / $1,221.03
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $1,791.32 / $11,102.00
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,475.60 / $3,475.60 / $4,110.83