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Pennsylvania rates for HCPCS 15758

Free fascial flap with microvascular anastomosis

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,084.00 / $3,748.00 / $8,017.00
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,531.00 / $27,840.00 / $46,480.74
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,027.15 / $4,027.15 / $4,027.15
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,013.00 / $4,068.00 / $8,017.00
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,553.94 / $2,553.94 / $2,553.94
Priority Health
Facility/Professional
Facility
Modifier
62
Low / Median / High Price
$1,572.60 / $1,572.60 / $1,572.60
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,213.07 / $2,213.07 / $2,904.21
UPMC Health Plan
Facility/Professional
Facility
Modifier
62
Low / Median / High Price
$2,183.91 / $2,183.91 / $2,183.91
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,122.00 / $2,884.00 / $6,000.00