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New Hampshire 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
$2,398.83 / $4,365.16 / $11,481.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,148.15 / $1,318.26 / $2,570.40
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15,135.61 / $25,703.96 / $38,904.51
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,202.26 / $2,511.89 / $3,715.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.00 / $1,905.46 / $3,388.44
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Low / Median / High Price
$851.14 / $4,466.84 / $10,000.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,348.96 / $1,995.26 / $3,162.28
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$851.14 / $4,466.84 / $10,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,318.26 / $1,949.84 / $3,467.37
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$933.25 / $1,348.96 / $1,584.89