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Michigan 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
$4,073.80 / $4,073.80 / $4,897.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.90 / $1,380.38 / $2,238.72
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$363.08 / $426.58 / $426.58
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.38 / $2,089.30 / $2,238.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,230.27 / $1,698.24 / $3,715.35
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,318.26 / $4,073.80 / $4,897.79
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,202.26 / $1,445.44 / $1,949.84
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.52 / $1,513.56 / $2,818.38
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,047.13 / $4,786.30 / $17,378.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,202.26 / $1,548.82 / $2,187.76