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Washington rates for HCPCS 49084

Peritoneal Lavage W/Wo Imaging Guidance

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$192.63 / $3,810.00 / $18,711.00
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $2,492.14 / $3,393.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$500.00 / $715.69 / $1,192.33
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$121.77 / $235.03 / $1,090.64
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$158.29 / $203.56 / $214.88
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$143.15 / $269.99 / $666.60
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,665.80 / $2,568.87 / $4,913.96
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$650.00 / $1,120.00 / $6,857.00