| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $363.08 | $2,398.83 | $9,772.37 | |
Harvard Pilgrim
| Facility | $7,413.10 | $7,413.10 | $7,413.10 | |
United
| Facility | $7,413.10 | $7,413.10 | $7,413.10 |
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 | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $363.08 | $2,398.83 | $9,772.37 | |
Harvard Pilgrim
| Facility | $7,413.10 | $7,413.10 | $7,413.10 | |
United
| Facility | $7,413.10 | $7,413.10 | $7,413.10 |