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Pennsylvania rates for HCPCS 15750

Flap; neurovascular pedicle

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$851.28 / $2,868.00 / $8,017.00
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,058.35 / $6,182.00 / $17,094.48
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$934.00 / $3,120.00 / $8,017.00
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,051.97 / $1,051.97 / $1,051.97
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$900.80 / $900.80 / $993.34
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,440.00 / $3,475.00 / $6,368.00