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Wisconsin 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
$398.11 / $1,737.80 / $4,786.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.54 / $501.19 / $1,412.54
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,011.87 / $7,943.28 / $12,589.25
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $912.01 / $2,137.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,230.27 / $1,445.44 / $2,290.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $1,047.13 / $1,412.54
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$436.52 / $1,412.54 / $6,918.31
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $1,174.90 / $1,412.54
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$446.68 / $2,570.40 / $11,481.54
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.68 / $831.76 / $1,949.84
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $70.79
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $1,071.52 / $1,584.89
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,585.78 / $7,585.78 / $11,220.18
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.63 / $776.25 / $3,467.37
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $2,041.74 / $2,290.87
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,606.93 / $10,232.93 / $12,589.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.68 / $724.44 / $1,862.09