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Virginia 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
$872.41 / $5,882.86 / $11,024.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$418.58 / $490.12 / $847.71
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,032.00 / $6,548.00 / $7,221.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$435.33 / $567.23 / $780.46
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$499.56 / $516.34 / $5,036.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$542.73 / $542.73 / $542.73
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$461.99 / $591.04 / $956.04
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$505.00 / $559.03 / $665.51
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$426.54 / $543.05 / $735.18
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$620.00 / $765.61 / $1,124.85
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$494.19 / $667.16 / $7,030.19
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$494.19 / $667.16 / $7,030.19
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,303.00 / $9,270.00 / $17,192.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$395.40 / $532.29 / $892.12