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Missouri rates for HCPCS 49084

Peritoneal lavage, including imaging guidance, when performed

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,110.00 / $3,214.00 / $7,365.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$862.00 / $1,785.00 / $4,773.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,652.00 / $1,652.00 / $1,652.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$98.25 / $157.38 / $1,639.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,300.00 / $2,332.00 / $3,071.00