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Maine rates for HCPCS 43775

Laps Gstrc Rstrictiv Px Longitudinal Gastrectomy

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,903.21 / $15,458.40 / $27,244.35
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20,209.48 / $26,469.21 / $29,847.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$699.00 / $699.00 / $1,264.70
Cigna
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$123.14 / $123.14 / $123.14
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,903.21 / $15,237.88 / $27,244.35