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Pennsylvania 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
$173.35 / $2,240.00 / $6,608.54
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,000.00 / $8,639.91 / $79,506.39
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$94.88 / $1,541.67 / $4,012.55
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$300.30 / $1,837.94 / $6,992.87
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$144.38 / $158.04 / $200.82
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$162.00 / $577.00 / $3,742.00