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Ohio rates for HCPCS 15769

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

Facilitymedian $5,129 · 10th–90th $759$11,7490%10%10th90th$5,129Professionalmedian $513 · 10th–90th $380$1,4130%20%10th90th$513$5.0$20.0$100.0$500.0$2.0K$10.0K

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
$758.58 / $5,128.61 / $11,748.98
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$346.74 / $501.19 / $3,019.95
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,698.24 / $3,548.13 / $15,135.61
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$436.52 / $549.54 / $912.01
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$467.74 / $467.74 / $467.74
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$21,379.62 / $21,379.62 / $21,379.62
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$407.38 / $645.65 / $977.24
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$4,168.69 / $4,168.69 / $21,379.62
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$416.87 / $660.69 / $977.24
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $389.05
SummaCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $100.00 / $4,365.16
SummaCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$436.52 / $537.03 / $870.96
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,691.53 / $5,754.40 / $9,332.54
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$398.11 / $512.86 / $831.76