go back

Virginia rates for HCPCS 49084

Peritoneal Lavage W/Wo Imaging Guidance

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$122.16 / $3,991.00 / $8,920.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,735.00 / $2,390.00 / $2,954.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$121.52 / $511.22 / $664.58
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.10 / $125.13 / $290.45
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$110.15 / $136.44 / $201.56
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$107.61 / $131.53 / $247.78
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$490.00 / $2,521.00 / $5,226.00