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Nebraska 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
$4,917.20 / $8,355.33 / $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
$850.19 / $1,445.32 / $2,747.36
Medica
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$1,008.48 / $1,008.48 / $1,008.48
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,603.14 / $2,150.01 / $3,376.46
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,148.00 / $9,696.00 / $19,670.00