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Texas rates for HCPCS 43775

Laps Gstrc Rstrictiv Px Longitudinal Gastrectomy

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,057.84 / $5,676.52 / $16,046.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,137.07 / $1,918.03 / $13,714.86
Baylor Scott & White
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,061.97 / $4,581.64 / $8,000.00
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$979.33 / $979.33 / $1,026.79
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$900.00 / $11,682.00 / $15,735.00
Cigna
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$123.14 / $123.14 / $123.14
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $15,184.32 / $22,630.00
Lucent Health
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$245.18 / $502.13 / $521.04
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,047.29 / $1,362.86 / $2,472.41
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,047.29 / $1,378.78 / $2,530.71
Providence
Facility/Professional
Facility
Modifier
80
Low / Median / High Price
$424.37 / $424.37 / $424.37
Providence
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$123.14 / $360.71 / $360.71
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,600.00 / $8,142.00 / $18,555.00