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Indiana 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
$1,479.11 / $2,344.23 / $4,897.79
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,456.54 / $14,125.38 / $19,054.61
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,318.26 / $1,348.96 / $1,548.82
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$758.58 / $2,344.23 / $2,344.23
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,023.29 / $5,623.41 / $12,022.64