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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
$3,363.43 / $7,923.64 / $19,148.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$243.45 / $437.41 / $1,159.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,335.87 / $4,387.57 / $8,486.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$422.74 / $713.52 / $960.77
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$880.96 / $1,082.17 / $1,366.56
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$437.41 / $831.08 / $8,816.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$567.78 / $996.53 / $1,327.76
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$880.96 / $1,366.56 / $3,908.14
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$880.96 / $1,100.00 / $1,475.61
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,341.00 / $7,441.00 / $8,816.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$567.78 / $996.53 / $1,129.83