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New York rates for HCPCS 49084

Peritoneal lavage, including imaging guidance, when performed

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$129.82 / $3,020.00 / $8,442.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,651.00 / $3,263.00 / $4,636.00
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$151.59 / $1,254.00 / $6,213.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$121.52 / $121.52 / $3,479.91
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.00 / $165.48 / $346.00
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$98.77 / $98.77 / $98.77
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$121.52 / $555.00 / $3,479.91
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,269.00 / $3,612.00 / $8,133.00
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$125.36 / $125.36 / $239.49