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Idaho 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
$1,628.00 / $4,500.00 / $7,205.00
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$589.34 / $791.41 / $1,021.56
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,327.80 / $4,697.79 / $5,755.74
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,450.00 / $6,124.00 / $7,609.00