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Maine rates for HCPCS 43622

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,304.96 / $2,759.91 / $2,850.99
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,224.20 / $16,010.56 / $18,053.93
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,416.94 / $3,127.82 / $4,736.77
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$699.00 / $699.00 / $2,631.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,976.56 / $3,315.21 / $4,992.02
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,569.51 / $3,309.32 / $5,178.51
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,304.96 / $2,759.91 / $5,346.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,260.28 / $3,236.92 / $4,520.56