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Arizona rates for HCPCS 15773

Grafting of autologous fat harvested by liposuction technique to face, eyelids, mouth, neck, ears, orbits, genitalia, hands, and/or feet; 25 cc or less injectate

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,160.86 / $2,897.00 / $6,483.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$587.35 / $2,197.38 / $3,616.69
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,807.43 / $1,807.43 / $1,807.43
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$483.09 / $654.36 / $2,421.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,424.00 / $2,522.00 / $5,029.00