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South Dakota rates for HCPCS 15774

Grafting of autologous fat harvested by liposuction technique to face, eyelids, mouth, neck, ears, orbits, genitalia, hands, and/or feet; each additional 25 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
$67.08 / $134.55 / $179.33
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$167.81 / $227.39 / $426.84
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$306.81 / $402.27 / $572.52
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$189.43 / $280.11 / $366.79
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$821.00 / $821.00 / $821.00