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Utah rates for HCPCS 49400

Injection Air/Contrast Peritoneal Cavity Spx

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$131.55 / $2,164.00 / $4,387.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.18 / $148.55 / $268.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.88 / $173.45 / $274.64
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.37 / $122.02 / $150.99
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$127.64 / $193.64 / $259.57
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,078.00 / $1,556.00 / $4,495.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.26 / $186.75 / $298.80