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Montana rates for HCPCS 15758

Free fascial flap with microvascular anastomosis

Insurance Carrier
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,548.13 / $3,548.13 / $3,548.13
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,801.89 / $3,981.07 / $4,168.69
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,949.84 / $2,454.71 / $3,981.07