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Hawaii rates for HCPCS 43622

Gastrectomy, total; with formation of intestinal pouch, any type

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,747.00 / $2,747.00 / $2,747.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,996.76 / $2,201.55 / $2,764.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,129.98 / $2,740.04 / $5,745.60
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,955.88 / $3,321.02 / $3,819.17
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,323.55 / $2,630.44 / $3,068.84
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,446.00 / $2,446.00 / $2,446.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,193.42 / $2,802.70 / $4,056.81
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.27 / $2,019.94 / $3,135.26