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Oklahoma 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
$1,288.25 / $3,162.28 / $7,762.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.19 / $467.74 / $851.14
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,479.11 / $1,479.11 / $1,479.11
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,128.61 / $7,943.28 / $12,882.50
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $575.44 / $630.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $645.65 / $758.58
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$457.09 / $1,584.89 / $7,079.46
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $524.81 / $3,548.13
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,230.27 / $4,265.80 / $8,317.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.54 / $501.19 / $676.08