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Maine rates for HCPCS 43771

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,148.15 / $1,380.38 / $2,570.40
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20,892.96 / $22,387.21 / $29,512.09
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,202.26 / $1,862.09 / $3,019.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$691.83 / $691.83 / $2,187.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $1,659.59 / $3,090.30
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,445.44 / $2,187.76 / $3,801.89
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.90 / $1,905.46 / $4,073.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.93 / $1,778.28 / $2,818.38