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Montana rates for HCPCS 43634

Gastrectomy, partial, distal; with formation of intestinal pouch

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,769.57 / $2,083.36 / $10,934.90
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,342.51 / $3,342.51 / $3,342.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,876.19 / $3,329.11 / $6,051.50
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,740.06 / $2,681.49 / $3,824.10
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,097.65 / $3,416.37 / $5,692.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,918.22 / $3,601.21 / $4,613.97