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Massachusetts 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
$725.64 / $1,758.00 / $3,693.00
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$818.35 / $3,133.00 / $4,952.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$623.12 / $778.15 / $1,373.14
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$504.48 / $1,091.44 / $6,679.00
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $3,466.74 / $8,498.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,640.00 / $3,372.00 / $8,425.00