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New Hampshire 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
$2,398.83 / $3,388.44 / $14,791.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.19 / $436.52 / $645.65
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,467.37 / $4,677.35 / $6,309.57
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $851.14 / $1,230.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,495.41 / $5,495.41 / $5,495.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.63 / $676.08 / $1,258.93
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,000.00 / $10,000.00 / $10,000.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $891.25 / $1,412.54
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,000.00 / $10,000.00 / $10,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $794.33 / $1,659.59
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$489.78 / $489.78 / $602.56