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Maine rates for HCPCS 43644

Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and Roux-en-Y gastroenterostomy (roux limb 150 cm or less)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,917.53 / $32,990.05 / $47,911.96
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20,209.48 / $26,469.21 / $29,847.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$699.00 / $699.00 / $1,980.11
Cigna
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$194.20 / $194.20 / $194.20
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,917.53 / $26,674.26 / $47,911.96