go back

Texas 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
$682.02 / $2,747.00 / $7,542.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,798.65 / $4,733.89 / $9,198.81
Baylor Scott & White
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,600.00 / $3,621.06 / $8,000.00
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$461.04 / $3,494.85 / $3,494.85
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,809.63 / $2,809.63 / $2,809.63
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $55.00 / $2,609.75
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$449.99 / $595.60 / $1,083.11
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$449.99 / $607.48 / $1,123.45
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,634.00 / $4,313.00 / $10,600.00