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Maryland 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
$2,041.74 / $2,041.74 / $2,041.74
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.97 / $245.47 / $398.11
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.82 / $128.82 / $128.82