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Idaho rates for HCPCS 43622

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,500.00 / $4,500.00 / $5,519.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,256.10 / $3,104.66 / $6,613.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,084.26 / $3,533.18 / $4,316.51
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,210.64 / $3,973.96 / $7,009.98
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,703.46 / $3,927.91 / $4,489.04
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $3,114.99 / $3,918.86
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,913.55 / $4,580.04 / $4,657.08
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,700.00 / $15,298.00 / $26,104.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,413.42 / $3,229.43 / $4,997.22