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South Dakota rates for HCPCS 15772

Grafting of autologous fat harvested by liposuction technique to trunk, breasts, scalp, arms, and/or legs; each additional 50 cc injectate, or part thereof (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.59 / $183.38 / $183.38
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$173.60 / $249.43 / $821.00
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$318.51 / $414.13 / $584.01
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$193.50 / $289.16 / $375.85
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$821.00 / $821.00 / $821.00