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Ohio 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
$513.21 / $2,785.00 / $9,516.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,145.00 / $2,786.00 / $8,800.00
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$474.17 / $569.00 / $704.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21,571.00 / $21,571.00 / $21,571.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,689.00 / $2,665.00 / $5,268.00