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Texas 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
$218.37 / $2,017.00 / $6,762.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,845.00 / $5,646.00 / $8,585.00
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$119.31 / $119.31 / $119.31
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $55.00 / $701.67
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$133.00 / $177.44 / $310.52
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$133.69 / $181.13 / $350.02
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$161.00 / $1,058.00 / $2,668.00