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Michigan rates for HCPCS 15758

Free fascial flap with microvascular anastomosis

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,672.33 / $4,112.00 / $4,933.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,824.53 / $12,616.37 / $17,093.18
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,411.67 / $4,112.00 / $4,933.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,524.00 / $5,806.00 / $8,884.00