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Arizona rates for HCPCS 49905

Omental flap, intra-abdominal (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,041.74 / $3,890.45 / $7,943.28
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$831.76 / $2,187.76 / $3,981.07
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$331.13 / $457.09 / $6,025.60
Medica
Facility/Professional
Facility
Modifier
62
Low / Median / High Price
$537.03 / $537.03 / $1,000.00
Medica
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$85.11 / $85.11 / $158.49
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,174.90 / $5,623.41 / $8,317.64