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Nebraska 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
$3,235.94 / $7,079.46 / $12,589.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $489.78 / $1,513.56
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,311.31 / $4,365.16 / $8,511.38
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$426.58 / $724.44 / $1,047.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.11 / $1,096.48 / $1,380.38
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$436.52 / $831.76 / $8,912.51
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $977.24 / $3,548.13
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $1,096.48 / $1,479.11
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,047.13 / $1,380.38
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,365.16 / $5,495.41 / $8,912.51
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $954.99 / $1,174.90