go back

Pennsylvania 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
$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