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Montana 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
$255.00 / $255.00 / $255.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47,000.00 / $81,499.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$223.99 / $223.99 / $223.99
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$111.78 / $146.46 / $223.99
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$231.84 / $231.84 / $231.84