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Indiana rates for HCPCS 43622

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,200.82 / $2,431.52 / $4,846.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,115.42 / $2,303.50 / $3,102.11
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,600.00 / $11,226.46 / $15,429.17
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,595.75 / $1,916.80 / $2,721.85
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,026.27 / $2,634.15 / $3,039.41
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,026.27 / $2,431.52 / $3,039.41
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$761.00 / $761.00 / $2,631.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,909.47 / $2,629.46 / $4,630.89
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$612.00 / $5,076.00 / $10,396.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,939.60 / $2,525.19 / $4,415.06