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Montana rates for HCPCS 49400

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.39 / $141.13 / $770.06
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.81 / $138.81 / $138.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.61 / $160.05 / $353.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$86.22 / $139.30 / $301.41
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.93 / $220.33 / $376.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$203.24 / $244.85 / $304.83