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Utah 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
$3,162.28 / $4,570.88 / $13,803.84
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,137.96 / $2,570.40 / $3,801.89
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,019.95 / $5,128.61 / $15,848.93