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Illinois rates for HCPCS 43634

Gastrectomy, partial, distal; with formation of intestinal pouch

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,148.15 / $4,073.80 / $8,511.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,949.84 / $2,290.87 / $4,466.84
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,332.54 / $25,118.86 / $47,863.01
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$398.11 / $398.11 / $588.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,659.59 / $2,884.03 / $4,677.35
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,041.74 / $4,073.80 / $10,000.00
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,398.83 / $2,754.23 / $3,090.30
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $3,019.95
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$575.44 / $2,818.38 / $7,413.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,905.46 / $2,570.40 / $4,466.84