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Texas rates for HCPCS 49084

Peritoneal lavage, including imaging guidance, when performed

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$632.00 / $2,594.00 / $7,542.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$675.89 / $1,249.60 / $2,774.30
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.13 / $77.13 / $94.05
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$544.67 / $722.59 / $1,652.00
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $55.00 / $2,855.25
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.81 / $122.17 / $239.14
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.81 / $124.83 / $244.78
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$597.00 / $2,045.00 / $4,480.00