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New Hampshire rates for HCPCS 43622

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $7,868.61 / $7,868.61
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,201.55 / $2,304.96 / $2,990.65
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,476.90 / $9,132.04 / $17,364.89
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,244.52 / $4,026.25 / $6,441.27
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,114.50 / $4,229.75 / $6,890.25
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,569.51 / $4,444.74 / $7,930.79
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$451.00 / $3,360.00 / $7,448.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,285.57 / $3,441.80 / $6,742.86
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,815.05 / $2,154.90 / $3,201.75