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Nebraska 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
$549.00 / $4,778.89 / $13,841.56
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,335.87 / $4,520.96 / $8,486.99
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$548.45 / $837.16 / $3,528.72
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,102.00 / $1,369.47 / $1,865.65
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,044.00 / $3,726.00 / $7,934.00