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Utah rates for HCPCS 49084

Peritoneal Lavage W/Wo Imaging Guidance

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$130.90 / $3,064.00 / $4,707.00
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,338.59 / $1,718.74 / $2,504.69
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,689.00 / $2,312.00 / $4,640.00