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New York 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
$601.61 / $3,621.00 / $9,038.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,100.00 / $7,264.00 / $12,274.00
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$676.90 / $1,254.00 / $8,917.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$849.51 / $849.51 / $13,296.25
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$250.00 / $498.83 / $1,326.02
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,568.42 / $2,568.42 / $2,568.42
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$555.00 / $849.51 / $13,296.25
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,768.00 / $4,176.00 / $8,312.00
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$538.76 / $538.76 / $637.08