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Michigan rates for HCPCS 43634

Gastrectomy, partial, distal; with formation of intestinal pouch

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,749.90 / $4,933.00 / $4,933.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,879.22 / $2,460.63 / $2,749.90
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,789.70 / $11,517.09 / $15,438.34
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$540.62 / $1,987.57 / $3,498.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,663.42 / $2,581.21 / $4,865.02
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,221.23 / $4,933.00 / $4,933.00
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,138.56 / $2,342.23 / $3,376.56
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$193.50 / $1,646.56 / $2,591.69
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$850.00 / $4,645.00 / $6,036.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,128.76 / $2,814.40 / $3,555.44