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Wisconsin rates for HCPCS 43774

Laps Gastric Restrictive Px Remove Device & Port

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,015.03 / $3,376.18 / $14,482.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,060.00 / $7,774.00 / $12,204.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,371.75 / $2,771.58 / $4,251.67
Cigna
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$107.75 / $107.75 / $107.75
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$901.68 / $1,148.63 / $1,977.71
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$901.43 / $1,302.32 / $16,461.00
Medica
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$1,008.48 / $1,008.48 / $1,008.48
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$901.68 / $1,149.81 / $1,977.71
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,746.00 / $2,328.58 / $3,824.46
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,095.64 / $13,326.00 / $13,326.00
Quartz
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$107.75 / $1,008.48 / $1,008.48
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,775.00 / $14,566.00 / $20,827.00