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Nebraska rates for HCPCS 43772

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,382.00 / $8,477.27 / $19,276.96
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,219.04 / $16,264.47 / $28,543.08
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$840.13 / $1,428.22 / $2,713.92
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,524.00 / $2,093.15 / $2,960.61
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,341.00 / $7,441.00 / $19,670.00