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Pennsylvania 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
$657.00 / $4,676.00 / $8,247.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$242.92 / $436.20 / $1,088.00
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,639.91 / $11,851.00 / $28,970.26
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$480.37 / $692.91 / $812.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$415.97 / $550.24 / $962.13
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.52 / $739.95 / $765.92
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$418.25 / $4,312.60 / $20,543.59
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$708.15 / $4,761.00 / $8,247.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$246.01 / $495.90 / $1,426.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$534.10 / $534.10 / $550.40
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$542.73 / $542.73 / $542.73
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.09 / $556.92 / $1,008.32
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$468.98 / $468.98 / $533.29
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$468.98 / $471.09 / $533.29
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,155.00 / $3,475.00 / $6,368.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$414.84 / $534.62 / $957.21