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West 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
$453.53 / $30,305.60 / $30,305.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$431.22 / $483.34 / $543.41
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$470.35 / $564.41 / $614.95
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$546.62 / $546.62 / $546.62
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$542.73 / $542.73 / $542.73
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$387.19 / $570.30 / $1,274.33
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,402.30 / $3,402.30 / $11,716.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$383.35 / $611.79 / $894.46