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Indiana rates for HCPCS 43634

Gastrectomy, partial, distal; with formation of intestinal pouch

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,024.98 / $3,500.00 / $15,757.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,890.44 / $2,118.58 / $2,854.26
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,600.00 / $11,226.46 / $15,429.17
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,522.96 / $1,903.70 / $2,627.10
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,865.09 / $2,424.62 / $2,797.64
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,865.09 / $2,140.19 / $2,797.64
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$761.00 / $761.00 / $2,420.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,630.74 / $2,374.60 / $4,120.64
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$612.00 / $5,076.00 / $10,396.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,680.60 / $2,327.69 / $4,647.43