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South Dakota 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
$309.03 / $309.03 / $4,365.16
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$281.84 / $524.81 / $977.24
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $794.33 / $831.76
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.38 / $575.44 / $676.08
Sanford Health Plan
Facility/Professional
Professional
Modifier
80
Low / Median / High Price
$134.90 / $134.90 / $134.90
Sanford Health Plan
Facility/Professional
Professional
Modifier
AS
Low / Median / High Price
$134.90 / $134.90 / $134.90
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,466.84 / $4,466.84 / $4,466.84