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Virginia rates for HCPCS 15771

Grafting Of Autologous Fat By Lipo 50 Cc Or Less

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$627.80 / $4,564.91 / $9,583.33
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,032.00 / $6,548.00 / $7,221.00
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$491.51 / $702.11 / $856.09
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$519.21 / $684.87 / $988.72
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$505.22 / $661.93 / $5,122.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,303.00 / $9,373.00 / $17,192.00