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Pennsylvania 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
$151.13 / $1,926.00 / $7,197.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.82 / $136.04 / $189.02
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,000.00 / $8,639.91 / $79,506.39
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$145.81 / $151.32 / $151.32
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$153.58 / $880.00 / $2,269.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.45 / $156.69 / $278.32
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$195.26 / $195.26 / $195.26
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$172.88 / $228.77 / $292.30
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,777.34 / $1,777.34 / $1,777.34
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.64 / $106.64 / $106.64
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$540.00 / $2,326.00 / $7,799.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.20 / $151.13 / $529.00
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.30 / $128.30 / $128.30
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.40 / $143.00 / $316.80
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$153.58 / $880.00 / $2,269.00
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.16 / $157.86 / $278.32
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.87 / $117.35 / $179.45
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.87 / $142.91 / $155.21
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.00 / $541.00 / $3,742.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$121.72 / $175.58 / $285.85