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Illinois rates for HCPCS 43622

Gstrct Tot W/Frmj Intstinal Pouch Any Type

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,159.00 / $3,936.67 / $5,549.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,128.02 / $2,497.76 / $4,456.62
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,559.73 / $27,378.16 / $54,824.76
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,840.65 / $3,403.31 / $4,248.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$400.00 / $785.00 / $2,631.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,129.13 / $3,335.19 / $5,050.17
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,379.92 / $3,823.51 / $11,339.13
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,596.30 / $3,010.40 / $3,384.84
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $32.34 / $3,827.47
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$557.00 / $2,873.00 / $6,625.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,262.98 / $3,125.68 / $5,496.46