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South Carolina rates for HCPCS 15769

Grafting Of Autologous Soft Tiss By Direct Exc

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$521.11 / $9,062.00 / $16,467.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$431.22 / $490.12 / $743.13
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$399.02 / $399.02 / $399.02
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$611.99 / $1,146.35 / $1,952.01
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$445.83 / $558.00 / $736.56
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,200.28 / $3,200.28 / $3,200.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$444.98 / $591.04 / $737.09
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$447.97 / $599.28 / $664.93
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,872.87 / $2,872.87 / $2,872.87
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.87 / $363.89 / $574.47
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,155.00 / $12,798.00 / $19,665.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$375.15 / $467.26 / $1,071.47