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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
$323.59 / $2,630.27 / $10,232.93
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $151.36 / $1,995.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.19 / $512.86 / $794.33
Cigna
Facility/Professional
Facility
Modifier
62
Low / Median / High Price
$371.54 / $371.54 / $371.54
Cigna
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$60.26 / $60.26 / $60.26
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.95 / $2,137.96 / $2,137.96
Lucent Health
Facility/Professional
Facility
Modifier
62
Low / Median / High Price
$1,348.96 / $1,348.96 / $1,348.96
Lucent Health
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$213.80 / $213.80 / $213.80
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,548.82 / $5,623.41 / $10,000.00