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South Dakota 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
$486.04 / $588.60 / $7,675.76
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$604.17 / $821.41 / $1,537.93
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,089.85 / $1,497.96 / $3,425.33
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.75 / $995.73 / $1,200.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,143.00 / $3,143.00 / $3,143.00