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Pennsylvania 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
$555.59 / $2,180.00 / $7,567.23
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,058.35 / $6,182.00 / $17,094.48
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,112.89 / $1,931.91 / $9,386.00
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$652.00 / $2,675.00 / $8,017.00
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$488.08 / $535.54 / $639.33
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$912.00 / $2,391.00 / $4,789.00