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Indiana rates for HCPCS 15772

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
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$157.81 / $4,148.16 / $9,160.94
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$130.32 / $130.32 / $251.52
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$135.49 / $172.68 / $234.09
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$933.00 / $2,252.00 / $4,426.00