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Utah 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
$208.93 / $3,019.95 / $4,570.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $144.54 / $269.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.71 / $165.96 / $309.03
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $218.78
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.03 / $194.98 / $281.84
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.65 / $186.21 / $316.23
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.82 / $190.55 / $275.42
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,071.52 / $4,466.84 / $5,128.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $141.25 / $234.42