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West Virginia 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
$137.82 / $174.40 / $1,400.00
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$152.58 / $152.58 / $187.18
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$244.66 / $244.66 / $244.66
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$460.00 / $460.00 / $460.00