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Ohio 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
$218.80 / $2,989.00 / $9,504.00
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$140.81 / $176.01 / $209.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21,571.00 / $21,571.00 / $21,571.00
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.11 / $969.88 / $2,771.42
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$444.00 / $979.00 / $3,218.00