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Montana rates for HCPCS 43772

Laparoscopy, surgical, gastric restrictive procedure; removal of adjustable gastric restrictive device component only

Insurance Carrier
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
$1,513.56 / $1,513.56 / $1,513.56
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,584.89 / $1,659.59 / $1,995.26
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$933.25 / $1,348.96 / $2,344.23