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Washington 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
$2,570.40 / $3,630.78 / $20,892.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.19 / $707.95 / $954.99
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,445.44 / $2,511.89 / $3,630.78
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,290.87 / $2,630.27 / $2,818.38
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,862.09 / $1,862.09 / $1,905.46
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$707.95 / $1,258.93 / $5,754.40