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Indiana rates for HCPCS 15774

Grafting of autologous fat harvested by liposuction technique to face, eyelids, mouth, neck, ears, orbits, genitalia, hands, and/or feet; each additional 25 cc injectate, or part thereof (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$118.28 / $341.55 / $5,634.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$125.60 / $125.60 / $242.41
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$131.13 / $167.14 / $227.64
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$866.00 / $2,291.00 / $4,426.00