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Michigan 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
$175.00 / $2,694.24 / $6,676.25
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$825.42 / $1,122.39 / $2,635.79
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$183.75 / $2,694.24 / $10,458.33
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$464.00 / $1,428.00 / $2,029.00