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Pennsylvania rates for HCPCS 15774

Grafting Of Autologous Fat By Lipo Ea Addl 25 Cc

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.98 / $2,240.00 / $7,629.00
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,000.00 / $8,639.91 / $79,506.39
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$617.00 / $2,371.00 / $8,017.00
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$140.38 / $151.83 / $194.61
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$226.00 / $557.00 / $3,742.00