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Hawaii rates for HCPCS 43634

Gastrectomy, partial, distal; with formation of intestinal pouch

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,747.00 / $2,747.00 / $2,747.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,807.75 / $2,025.03 / $2,517.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,990.61 / $2,524.23 / $5,281.91
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,721.23 / $3,057.39 / $3,516.00
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,140.54 / $2,423.26 / $2,827.13
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,446.00 / $2,446.00 / $2,446.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,021.29 / $2,524.23 / $3,491.55
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.27 / $1,859.59 / $2,800.32