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Wisconsin 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
$691.83 / $4,073.80 / $8,317.64
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,011.87 / $7,943.28 / $12,589.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,621.81 / $1,862.09 / $3,019.95
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$512.86 / $3,981.07 / $8,912.51
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$512.86 / $4,365.16 / $11,481.54
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $1,479.11 / $2,290.87
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,585.78 / $7,585.78 / $11,220.18
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,606.93 / $10,232.93 / $12,589.25