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New Mexico rates for HCPCS 43622

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,000.00 / $7,838.38 / $7,838.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,041.60 / $2,363.54 / $3,466.62
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,631.54 / $2,631.54 / $2,631.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,289.34 / $3,373.92 / $4,273.92
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $32.34 / $3,658.13
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,912.23 / $2,551.61 / $3,466.62
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,522.84 / $3,598.85 / $5,984.73
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$755.00 / $4,616.00 / $17,636.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,431.09 / $3,376.50 / $4,929.68