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New Hampshire 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
$2,290.87 / $5,248.07 / $9,772.37
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,890.45 / $10,964.78 / $16,982.44
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Low / Median / High Price
$446.68 / $3,388.44 / $7,413.10
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$446.68 / $3,388.44 / $7,413.10
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,023.29 / $1,202.26 / $1,737.80