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Indiana 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
$414.92 / $913.92 / $7,212.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,042.00 / $5,230.00 / $8,240.00
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$465.51 / $593.29 / $733.75
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,314.83 / $1,314.83 / $1,314.83
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,400.00 / $3,870.00 / $5,490.00