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Utah 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
$616.60 / $3,715.35 / $6,025.60
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,818.38 / $3,311.31 / $7,244.36
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $812.83 / $1,318.26
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,698.24 / $4,466.84 / $5,128.61