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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
$513.35 / $3,038.00 / $6,161.00
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,814.80 / $3,509.81 / $5,038.84
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,689.00 / $2,312.00 / $4,640.00