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South 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
$1,265.41 / $1,265.41 / $1,265.41
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,345.27 / $2,159.86 / $3,723.22
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,134.79 / $3,198.08 / $4,296.50
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,710.94 / $2,366.06 / $2,697.57
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,000.00 / $2,000.00 / $2,000.00