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Virginia 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
$1,621.81 / $3,630.78 / $9,549.93
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,760.83 / $11,220.18 / $15,848.93
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$489.78 / $524.81 / $616.60
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,230.27 / $1,479.11 / $2,454.71
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,905.46 / $2,137.96 / $3,235.94
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,348.96 / $1,862.09 / $2,818.38
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,380.38 / $1,737.80 / $3,388.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$407.38 / $3,019.95 / $6,309.57