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Michigan 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
$1,778.28 / $4,897.79 / $4,897.79
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.87 / $2,089.30 / $2,089.30
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,513.56 / $4,073.80 / $4,897.79
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$691.83 / $3,548.13 / $6,025.60