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Utah 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
$1,659.59 / $5,888.44 / $8,511.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,148.15 / $1,380.38 / $2,884.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $1,659.59 / $2,691.53
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $33.11
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,344.23 / $3,235.94 / $5,370.32
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.90 / $2,344.23 / $6,606.93
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,584.89 / $1,905.46 / $2,570.40
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,137.96 / $11,220.18 / $17,782.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,122.02 / $1,412.54 / $2,290.87