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Michigan rates for HCPCS 42815

Excision branchial cleft cyst, vestige, or fistula, extending beneath subcutaneous tissues and/or into pharynx

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$691.03 / $5,757.00 / $9,101.36
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,978.97 / $7,361.42 / $10,163.16
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$577.83 / $5,757.00 / $8,625.06
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,500.00 / $8,702.00 / $10,351.00