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South Dakota rates for HCPCS 49905

Omental Flap Intra-Abdominal

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$312.23 / $312.23 / $312.23
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$345.16 / $565.08 / $969.40
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$530.84 / $796.55 / $1,086.64
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$432.72 / $593.54 / $678.60
Sanford Health Plan
Facility/Professional
Professional
Modifier
80
Low / Median / High Price
$131.91 / $131.91 / $131.91
Sanford Health Plan
Facility/Professional
Professional
Modifier
AS
Low / Median / High Price
$131.91 / $131.91 / $131.91
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,500.00 / $4,500.00 / $4,500.00