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Montana rates for HCPCS 43775

Laparoscopy, surgical, gastric restrictive procedure; longitudinal gastrectomy (ie, sleeve gastrectomy)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,583.52 / $16,127.20 / $21,979.77
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47,000.00 / $77,999.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,736.72 / $1,736.72 / $1,736.72
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,021.39 / $1,736.72 / $2,385.79