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Tennessee rates for HCPCS 49084

Peritoneal lavage, including imaging guidance, when performed

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$290.88 / $2,311.00 / $6,681.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$888.00 / $2,090.00 / $2,948.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$375.00 / $633.42 / $1,487.00
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $2,855.25 / $2,855.25
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$875.00 / $2,257.00 / $4,099.00