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North Dakota 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
$1,379.21 / $1,379.21 / $8,500.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,179.02 / $1,792.97 / $3,026.33
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$681.00 / $681.00 / $681.00