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South Carolina rates for HCPCS 15758

Free Fascial Flap W/Microvascular Anastomosis

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,466.10 / $8,783.00 / $16,639.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,120.34 / $5,120.34 / $5,120.34
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$580.00 / $580.00 / $580.00
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,119.98 / $2,754.50 / $3,498.18
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$791.00 / $10,257.00 / $16,249.00