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Massachusetts rates for HCPCS 43622

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,201.55 / $2,747.00 / $4,806.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,996.76 / $2,304.96 / $3,417.26
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $2,854.00 / $20,701.04
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,168.00 / $4,322.72 / $16,210.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.00 / $680.00 / $748.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,606.23 / $3,763.07 / $7,907.58
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$300.00 / $3,343.00 / $6,679.00
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,566.98 / $3,243.69 / $4,764.87
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,842.21 / $5,565.05 / $6,883.33
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $2,446.00 / $20,701.04
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,437.13 / $4,556.72 / $16,210.16
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$789.00 / $2,446.00 / $4,050.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,273.35 / $3,340.05 / $7,432.66