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Texas rates for HCPCS 15758

Free fascial flap with microvascular anastomosis

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$872.00 / $3,224.00 / $11,453.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,286.55 / $3,977.64 / $19,902.49
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,904.19 / $1,904.19 / $1,943.88
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $2,000.00 / $12,811.25
Lucent Health
Facility/Professional
Facility
Modifier
62
Low / Median / High Price
$3,188.38 / $6,409.11 / $6,951.51
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,012.10 / $2,650.45 / $3,925.06
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,012.10 / $2,647.26 / $3,925.06
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,124.00 / $3,314.00 / $7,600.00