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South Dakota rates for HCPCS 15758

Free fascial flap with microvascular anastomosis

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,153.23 / $2,153.23 / $3,511.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,676.69 / $3,426.74 / $6,065.90
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,494.10 / $5,256.34 / $6,995.31
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,837.78 / $3,837.44 / $4,382.10
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,714.00 / $2,714.00 / $2,714.00