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Hawaii rates for HCPCS 49084

Peritoneal lavage, including imaging guidance, when performed

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,486.00 / $3,883.00 / $4,705.00
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.00 / $121.09 / $141.27
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,689.00 / $1,689.00 / $1,689.00