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Utah rates for HCPCS 15733

Muscle, myocutaneous, or fasciocutaneous flap; head and neck with named vascular pedicle (ie, buccinators, genioglossus, temporalis, masseter, sternocleidomastoid, levator scapulae)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,754.23 / $5,888.44 / $10,232.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $1,318.26 / $4,570.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $1,380.38 / $1,737.80
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $4,786.30
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,888.44 / $6,918.31 / $13,803.84
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.52 / $1,584.89 / $1,862.09
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $1,905.46 / $3,235.94
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,148.15 / $1,479.11 / $2,511.89
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,137.96 / $5,128.61 / $8,317.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $1,071.52 / $1,548.82