go back

Wisconsin 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
$851.14 / $2,089.30 / $14,454.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $1,047.13 / $2,570.40
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,011.87 / $7,943.28 / $12,589.25
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,949.84 / $4,570.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,630.27 / $3,090.30 / $4,897.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.52 / $2,238.72 / $3,019.95
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$933.25 / $2,951.21 / $6,918.31
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,819.70 / $2,511.89 / $3,162.28
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$954.99 / $3,019.95 / $11,481.54
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $1,819.70 / $4,265.80
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $70.79
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,548.82 / $2,137.96 / $3,162.28
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,585.78 / $7,585.78 / $11,220.18
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,698.24 / $7,413.10
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,819.70 / $4,365.16 / $4,897.79
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,606.93 / $10,232.93 / $12,589.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $1,584.89 / $4,073.80