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Montana rates for HCPCS 43653

Laparoscopy, surgical; gastrostomy, without construction of gastric tube (eg, Stamm procedure) (separate procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,691.53 / $2,691.53 / $5,128.61
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46,773.51 / $81,283.05 / $95,499.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$912.01 / $912.01 / $912.01
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$954.99 / $1,000.00 / $1,202.26
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$575.44 / $794.33 / $1,380.38