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Missouri rates for HCPCS 15758

Free fascial flap with microvascular anastomosis

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,760.00 / $4,470.00 / $8,000.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,224.00 / $4,517.00 / $10,778.96
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,662.03 / $2,680.00 / $6,592.93
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
$1,644.00 / $2,874.00 / $5,813.00