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Indiana rates for HCPCS 43774

Laparoscopy, surgical, gastric restrictive procedure; removal of adjustable gastric restrictive device and subcutaneous port components

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$920.87 / $2,318.00 / $12,295.76
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,058.00 / $7,572.00 / $18,942.00
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$851.23 / $1,106.59 / $1,276.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$761.00 / $1,095.64 / $2,513.90
Cigna
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$107.75 / $107.75 / $107.75
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,000.00 / $14,061.00 / $19,962.00