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South Dakota rates for HCPCS 15773

Grafting Of Autologous Fat By Lipo 25 Cc Or Less

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$481.25 / $580.38 / $3,080.15
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$589.25 / $784.28 / $1,385.10
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,104.64 / $1,465.44 / $1,865.65
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$605.90 / $971.42 / $1,170.89
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,000.00 / $2,000.00 / $2,000.00