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Wisconsin 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
$416.87 / $1,230.27 / $6,165.95
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,630.27 / $4,570.88 / $7,079.46
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,584.89 / $1,819.70 / $2,951.21
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.19 / $3,981.07 / $8,912.51
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$489.78 / $3,019.95 / $6,165.95
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $1,445.44 / $2,137.96
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,801.89 / $3,801.89 / $5,623.41
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,884.03 / $3,801.89 / $6,606.93