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Montana rates for HCPCS 43771

Laps Gastric Restrictive Px Revision Device

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,053.96 / $1,251.75 / $6,603.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,020.12 / $2,020.12 / $2,020.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,195.10 / $2,020.12 / $3,609.06
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,245.77 / $1,763.83 / $2,296.61
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.22 / $2,062.44 / $3,436.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,752.15 / $2,129.92 / $2,795.38