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Tennessee 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
$320.89 / $2,678.00 / $7,602.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$101.00 / $147.00 / $1,917.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$455.00 / $514.00 / $2,277.00
Cigna
Facility/Professional
Facility
Modifier
62
Low / Median / High Price
$243.96 / $243.96 / $243.96
Cigna
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$39.03 / $39.03 / $39.03
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $1,638.00 / $1,657.85
Lucent Health
Facility/Professional
Facility
Modifier
62
Low / Median / High Price
$488.91 / $1,036.16 / $1,036.16
Lucent Health
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$78.23 / $165.79 / $165.79
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,409.00 / $4,937.00 / $10,111.00