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Texas rates for HCPCS 15773

Grafting Of Autologous Fat By Lipo 25 Cc Or Less

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$538.00 / $2,396.00 / $7,542.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,541.43 / $2,596.38 / $5,517.32
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$442.91 / $442.91 / $442.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,408.30 / $1,408.30 / $1,408.30
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $55.00 / $3,466.74
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$459.30 / $583.60 / $1,082.96
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$459.30 / $598.14 / $1,140.59
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$564.00 / $2,100.00 / $4,554.00