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South Carolina rates for HCPCS 00402

Anesthesia Reconstruction Breast

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
AA
Low / Median / High Price
$2,561.90 / $2,561.90 / $2,561.90
Aetna
Facility/Professional
Facility
Modifier
QK
Low / Median / High Price
$2,020.11 / $2,020.11 / $2,132.82
Aetna
Facility/Professional
Facility
Modifier
QX
Low / Median / High Price
$3,327.24 / $3,327.24 / $3,512.88