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Pennsylvania 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
$542.03 / $3,774.28 / $8,509.00
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,639.91 / $11,851.00 / $28,970.26
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,513.11 / $8,698.70 / $13,455.36
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$810.00 / $4,417.92 / $8,832.62
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$494.70 / $529.72 / $633.50
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,222.00 / $3,475.00 / $6,000.00