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Washington 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
$468.91 / $995.92 / $20,680.40
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $478.48 / $1,638.00
Asuris Northwest Health
Facility/Professional
Facility
Modifier
62
Low / Median / High Price
$302.33 / $992.48 / $992.48
Asuris Northwest Health
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$48.37 / $158.80 / $158.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$500.00 / $714.97 / $947.00
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$330.77 / $707.16 / $874.65
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$502.74 / $665.34 / $701.49
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$472.03 / $472.03 / $478.48
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,400.00 / $3,509.00 / $16,315.00