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Arizona rates for HCPCS 15771

Grafting of autologous fat harvested by liposuction technique to trunk, breasts, scalp, arms, and/or legs; 50 cc or less injectate

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,188.72 / $4,248.00 / $7,562.14
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$672.35 / $2,515.38 / $4,140.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,605.92 / $3,605.92 / $3,605.92
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$493.35 / $668.27 / $4,702.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,878.00 / $4,545.00 / $7,217.00