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Illinois rates for HCPCS 49084

Peritoneal lavage, including imaging guidance, when performed

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$234.42 / $2,041.74 / $7,762.47
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$707.95 / $1,318.26 / $1,905.46
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$302.00 / $977.24 / $1,000.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.03 / $338.84 / $588.84
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$776.25 / $2,187.76 / $4,570.88