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New York 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
$178.60 / $3,302.88 / $8,711.20
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,100.00 / $7,264.00 / $12,274.00
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$196.06 / $196.06 / $8,917.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$252.65 / $252.65 / $14,648.00
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$91.58 / $180.00 / $390.67
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$229.85 / $1,740.63 / $2,943.50
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$252.65 / $555.00 / $74,999.25
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,079.00 / $2,871.00 / $5,384.00
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$157.25 / $157.25 / $186.30