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New Mexico 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
$193.52 / $2,145.78 / $4,286.64
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56,799.99 / $68,899.99 / $81,099.99
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$125.85 / $125.85 / $161.96
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$775.00 / $1,327.00 / $1,327.00