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Pennsylvania rates for HCPCS 49084

Peritoneal lavage, including imaging guidance, when performed

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$112.42 / $2,747.00 / $8,017.00
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,299.82 / $2,746.00 / $13,822.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$446.00 / $719.77 / $1,418.21
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$239.09 / $239.09 / $239.09
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$832.00 / $3,077.00 / $8,017.00
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$121.52 / $714.12 / $1,404.00
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$90.23 / $104.68 / $104.68
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$550.00 / $1,734.00 / $4,300.00