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South Carolina rates for HCPCS D4273

Autogenous Connective Tissue Graft Procedure

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$321.69 / $321.69 / $321.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$321.69 / $321.69 / $435.37
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,057.16 / $2,216.51 / $3,868.86
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$321.69 / $388.93 / $614.91
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.00 / $55.00 / $55.00