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Maine 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
$0.94 / $2,094.56 / $36,446.12
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.94 / $4,924.96 / $36,446.12