| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $432.41 | $5,084.91 | $13,413.92 | |
Moda Health
| Facility | $182.59 | $916.60 | $1,283.24 | |
Providence
| Facility | $182.59 | $916.60 | $1,283.24 |
Grafting of autologous fat harvested by liposuction technique to trunk, breasts, scalp, arms, and/or legs; each additional 50 cc injectate, or part thereof (List separately in addition to code for primary procedure)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $432.41 | $5,084.91 | $13,413.92 | |
Moda Health
| Facility | $182.59 | $916.60 | $1,283.24 | |
Providence
| Facility | $182.59 | $916.60 | $1,283.24 |