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Missouri rates for HCPCS 43622

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,760.00 / $4,261.00 / $12,154.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,128.02 / $2,417.41 / $3,418.89
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,234.00 / $4,319.00 / $10,043.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,017.59 / $2,714.84 / $4,226.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,530.00 / $2,530.00 / $2,530.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,979.11 / $3,038.51 / $5,090.43
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,899.26 / $2,912.63 / $5,936.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,245.35 / $4,188.18 / $16,589.28
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,189.00 / $3,300.00 / $11,186.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,193.42 / $3,196.22 / $6,299.39