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Montana 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
$255.00 / $255.00 / $19,658.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47,000.00 / $81,499.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$811.84 / $811.84 / $811.84
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$403.23 / $504.04 / $811.84