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Pennsylvania rates for HCPCS 43772

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,015.17 / $3,838.00 / $8,017.00
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,531.00 / $27,840.00 / $46,296.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$500.00 / $800.00 / $2,269.00
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,139.98 / $2,139.98 / $2,139.98
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,015.17 / $4,068.00 / $8,017.00
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,030.50 / $1,030.50 / $1,030.50
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$500.00 / $800.00 / $2,269.00
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$894.73 / $897.11 / $928.79
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,273.00 / $3,331.00 / $6,423.00