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Montana rates for HCPCS 43773

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,148.15 / $1,380.38 / $3,311.31
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,041.74 / $2,041.74 / $2,041.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,122.02 / $1,698.24 / $3,801.89
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,137.96 / $2,238.72 / $2,630.27
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,137.96 / $2,238.72 / $2,630.27
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,258.93 / $1,819.70 / $3,090.30
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $2,041.74 / $3,311.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,659.59 / $2,041.74 / $2,630.27