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Nebraska 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
$513.00 / $3,588.88 / $13,841.56
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,335.87 / $4,520.96 / $8,486.99
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$170.72 / $261.64 / $676.68
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$318.51 / $410.74 / $532.52
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,031.00 / $1,775.00 / $4,406.00