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Minnesota rates for HCPCS 49084

Peritoneal lavage, including imaging guidance, when performed

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.50 / $95.50 / $2,630.27
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,479.11 / $3,311.31 / $6,760.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$229.09 / $363.08 / $870.96
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$281.84 / $346.74 / $676.08
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.33 / $169.82 / $2,238.72
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,230.27 / $2,691.53 / $6,456.54