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Washington rates for HCPCS 15769

Grafting Of Autologous Soft Tiss By Direct Exc

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$617.79 / $5,918.50 / $18,711.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.11 / $510.43 / $1,159.00
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,399.07 / $10,166.93 / $19,448.18
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$653.73 / $1,139.10 / $4,200.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$644.92 / $1,110.00 / $4,636.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$546.26 / $827.89 / $1,463.15
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$625.40 / $1,055.83 / $4,240.71
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$659.04 / $1,097.71 / $4,065.76
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.83 / $379.89 / $1,065.46
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$676.94 / $941.61 / $970.16
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$641.00 / $661.74 / $1,961.22
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$662.79 / $1,094.94 / $1,313.48
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,418.65 / $10,161.12 / $19,448.18
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$646.09 / $899.95 / $1,239.43
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,403.00 / $2,428.00 / $11,941.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$595.98 / $741.65 / $1,392.23
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$522.79 / $522.79 / $522.79