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Pennsylvania 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
$1,301.00 / $3,839.00 / $8,113.00
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,531.00 / $27,840.00 / $46,296.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$500.00 / $800.00 / $2,151.00
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,097.44 / $3,097.44 / $3,097.44
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,013.00 / $4,761.00 / $8,247.00
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,537.30 / $1,537.30 / $1,537.30
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$500.00 / $800.00 / $2,151.00
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,239.56 / $1,286.36 / $1,357.18
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$388.00 / $2,020.00 / $6,322.00