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Michigan rates for HCPCS 49400

Injection of air or contrast into peritoneal cavity (separate procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$115.18 / $2,056.00 / $4,933.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.21 / $136.50 / $189.02
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$487.96 / $721.44 / $996.02
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.50 / $92.44 / $166.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.45 / $155.86 / $302.32
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$146.76 / $2,056.00 / $4,933.00
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.03 / $146.76 / $225.54
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.20 / $135.89 / $195.48
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$300.00 / $1,438.00 / $1,844.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$149.40 / $200.02 / $281.07