go back

Michigan rates for HCPCS 43622

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,019.95 / $4,897.79 / $4,897.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,137.96 / $2,511.89 / $3,981.07
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$691.83 / $3,467.37 / $3,467.37
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,041.74 / $3,467.37 / $3,467.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,137.96 / $2,951.21 / $6,309.57
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,398.83 / $4,897.79 / $7,079.46
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,187.76 / $2,570.40 / $3,467.37
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,949.84 / $2,691.53 / $5,128.61
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$691.83 / $3,548.13 / $6,025.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,137.96 / $2,818.38 / $3,890.45