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Illinois rates for HCPCS 15772

Grafting Of Autologous Fat By Lipo Ea Addl 50 Cc

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$126.60 / $1,055.00 / $5,389.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$780.53 / $1,669.60 / $3,343.37
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$875.00 / $875.00 / $908.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.37 / $300.05 / $808.44
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$165.00 / $900.00 / $3,686.00