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Montana rates for HCPCS 43622

Gastrectomy, total; with formation of intestinal pouch, any type

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,929.06 / $2,256.10 / $11,888.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,632.23 / $3,632.23 / $3,632.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,134.32 / $3,614.83 / $6,641.66
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,211.31 / $3,008.48 / $4,157.42
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,281.11 / $3,714.01 / $6,188.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,173.90 / $3,877.76 / $4,874.26