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Montana rates for HCPCS 43502

Gastrotomy; with suture repair of pre-existing esophagogastric laceration (eg, Mallory-Weiss)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,348.96 / $1,659.59 / $3,981.07
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,398.83 / $2,398.83 / $2,398.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,412.54 / $2,041.74 / $4,466.84
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,511.89 / $2,630.27 / $2,951.21
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,511.89 / $2,630.27 / $2,951.21
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,513.56 / $2,041.74 / $3,630.78
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $2,398.83 / $3,981.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,995.26 / $2,454.71 / $3,090.30