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New York rates for HCPCS 15758

Free fascial flap with microvascular anastomosis

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,005.13 / $4,778.00 / $10,024.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,283.00 / $5,434.00 / $12,008.00
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,212.59 / $3,212.59 / $37,499.62
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,553.94 / $2,553.94 / $2,553.94
Cigna
Facility/Professional
Facility
Modifier
62
Low / Median / High Price
$1,572.60 / $1,572.60 / $1,572.60
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$332.00 / $2,520.16 / $5,849.55
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$555.00 / $2,553.94 / $74,999.25
MVP Health Care
Facility/Professional
Facility
Modifier
62
Low / Median / High Price
$1,572.60 / $1,572.60 / $1,572.60
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,925.00 / $4,840.00 / $9,416.00
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,413.84 / $2,413.84 / $8,313.52