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Minnesota rates for HCPCS 49084

Peritoneal Lavage W/Wo Imaging Guidance

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.24 / $95.24 / $2,525.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,178.08 / $2,990.81 / $5,557.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$220.41 / $344.00 / $827.53
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$191.00 / $313.92 / $651.60
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.54 / $193.64 / $1,224.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,224.00 / $3,500.00 / $6,361.00