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Idaho rates for HCPCS 49904

Omental flap, extra-abdominal (eg, for reconstruction of sternal and chest wall defects)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,466.84 / $5,495.41 / $5,495.41
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,011.87 / $5,495.41 / $6,606.93
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,348.96 / $2,137.96 / $3,981.07
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,715.35 / $15,488.17 / $26,302.68