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South Carolina 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
$1,637.62 / $3,799.60 / $16,467.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $560.00 / $615.00
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,391.98 / $1,883.00 / $2,784.35
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$454.00 / $6,074.00 / $8,818.00