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Pennsylvania rates for HCPCS 43771

Laps Gastric Restrictive Px Revision Device

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,119.00 / $3,748.00 / $8,017.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,130.79 / $1,277.55 / $1,654.53
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,531.00 / $27,840.00 / $46,296.00
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,279.50 / $1,327.79 / $2,368.52
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$500.00 / $800.00 / $2,269.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,116.70 / $1,558.99 / $2,661.60
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,876.14 / $2,876.14 / $2,876.14
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,546.70 / $1,983.37 / $2,566.91
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,020.00 / $3,964.00 / $8,017.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,068.00 / $1,354.89 / $4,333.32
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,291.09 / $1,291.09 / $1,291.09
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.00 / $1,641.50 / $3,229.90
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$500.00 / $800.00 / $2,269.00
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,116.70 / $1,554.01 / $2,661.60
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$995.59 / $1,085.94 / $1,251.77
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$995.59 / $1,251.77 / $1,319.03
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,273.00 / $3,331.00 / $6,423.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,115.29 / $1,447.95 / $2,457.17