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Utah 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
$2,754.23 / $4,570.88 / $12,022.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.42 / $489.78 / $1,148.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.52 / $645.65 / $794.33
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $2,041.74
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,888.44 / $6,918.31 / $13,803.84
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $630.96 / $758.58
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$426.58 / $602.56 / $912.01
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $724.44 / $954.99
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,137.96 / $5,128.61 / $8,317.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.11 / $501.19 / $707.95