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Hawaii rates for HCPCS 43771

Laparoscopy, surgical, gastric restrictive procedure; revision of adjustable gastric restrictive device component only

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,778.28 / $4,466.84 / $4,466.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,148.15 / $1,288.25 / $1,905.46
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.93 / $1,621.81 / $4,786.30
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,737.80 / $2,187.76 / $7,943.28
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.90 / $1,412.54 / $1,778.28
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,137.96 / $2,137.96 / $2,137.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,148.15 / $1,584.89 / $2,089.30
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.80 / $1,513.56 / $1,949.84