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Washington rates for HCPCS 15769

Grafting of autologous soft tissue, other, harvested by direct excision (eg, fat, dermis, fascia)

Facilitymedian $4,467 · 10th–90th $724$17,7830%5%10%10th90th$4,467Professionalmedian $661 · 10th–90th $407$2,2910%10%10th90th$661$50.0$200.0$1.0K$5.0K$20.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$912.01 / $7,762.47 / $18,620.87
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$398.11 / $562.34 / $2,344.23
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$478.63 / $478.63 / $478.63
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$7,244.36 / $9,549.93 / $19,498.45
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$549.54 / $912.01 / $1,479.11
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$645.65 / $1,122.02 / $4,677.35
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$575.44 / $812.83 / $1,445.44
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$660.69 / $1,096.48 / $11,220.18
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$660.69 / $1,023.29 / $4,073.80
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $75.86
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$630.96 / $933.25 / $977.24
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$645.65 / $660.69 / $1,412.54
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$660.69 / $977.24 / $1,380.38
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$6,918.31 / $10,000.00 / $19,498.45
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$549.54 / $891.25 / $1,230.27
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,951.21 / $11,220.18 / $20,417.38
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$549.54 / $691.83 / $1,258.93
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$501.19 / $616.60 / $954.99