go back

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
$676.08 / $5,011.87 / $10,000.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.11 / $501.19 / $1,905.46
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,888.44 / $6,760.83 / $7,413.10
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.68 / $616.60 / $870.96
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $3,890.45 / $5,623.41
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.67 / $34.67 / $812.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $588.84 / $954.99
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.52 / $537.03 / $630.96
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.87 / $524.81 / $758.58
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $758.58 / $758.58
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$457.09 / $676.08 / $10,000.00
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $676.08 / $10,000.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,623.41 / $9,549.93 / $19,054.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.11 / $562.34 / $933.25