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Virginia 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
$545.39 / $3,633.00 / $8,294.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,060.00 / $3,693.00 / $4,290.00
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$481.49 / $685.87 / $833.95
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$515.88 / $667.16 / $997.75
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$512.14 / $669.20 / $3,512.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,911.00 / $3,276.00 / $5,340.00