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Arizona rates for HCPCS 15758

Free fascial flap with microvascular anastomosis

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,965.00 / $3,819.00 / $7,467.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,763.75 / $6,855.80 / $10,860.55
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,087.44 / $2,572.60 / $4,408.02
Medica
Facility/Professional
Facility
Modifier
62
Low / Median / High Price
$3,582.16 / $3,582.16 / $6,409.11
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,343.00 / $3,339.00 / $5,838.00