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Michigan rates for HCPCS 43763

Replacement of gastrostomy tube, percutaneous, includes removal, when performed, without imaging or endoscopic guidance; requiring revision of gastrostomy tract

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$111.43 / $487.06 / $4,933.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.20 / $169.28 / $415.24
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$266.23 / $362.98 / $870.35
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.15 / $85.94 / $150.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.23 / $275.29 / $627.82
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$127.49 / $2,056.00 / $4,933.00
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.37 / $326.01 / $443.47
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$242.43 / $302.43 / $438.52
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$300.00 / $1,438.00 / $1,844.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.24 / $420.45 / $612.64