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Indiana rates for HCPCS 43502

Gastrotomy; with suture repair of pre-existing esophagogastric laceration (eg, Mallory-Weiss)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,621.81 / $2,344.23 / $4,897.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,348.96 / $1,621.81 / $2,691.53
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,456.54 / $14,125.38 / $19,054.61
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $1,318.26 / $2,137.96
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,412.54 / $1,479.11 / $1,698.24
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,318.26 / $1,318.26 / $1,318.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,513.56 / $2,137.96 / $3,090.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.52 / $1,819.70 / $3,019.95
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,023.29 / $5,623.41 / $12,022.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.93 / $1,621.81 / $2,511.89