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Illinois rates for HCPCS 15758

Free Fascial Flap W/Microvascular Anastomosis

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,017.00 / $2,747.00 / $5,405.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,819.78 / $25,282.96 / $50,629.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$875.00 / $875.00 / $908.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,269.58 / $3,723.24 / $14,344.03
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,600.00 / $3,951.00 / $6,625.00