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Tennessee rates for HCPCS 43622

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,311.00 / $3,940.00 / $7,602.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,055.62 / $2,673.84 / $4,036.29
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$851.00 / $2,267.00 / $4,015.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,141.02 / $2,986.30 / $4,771.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$500.00 / $525.00 / $2,530.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,198.52 / $3,109.63 / $4,995.55
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $20,701.04 / $21,195.52
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16,210.16 / $16,589.28 / $19,860.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$875.00 / $2,397.00 / $4,544.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,022.82 / $2,884.43 / $4,936.17