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Vermont rates for HCPCS 49400

Injection Air/Contrast Peritoneal Cavity Spx

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.44 / $136.62 / $485.25
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$282.60 / $282.60 / $545.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$118.34 / $192.00 / $545.59
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$143.65 / $208.91 / $545.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.91 / $239.41 / $669.65