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New Hampshire rates for HCPCS 43634

Gastrectomy, partial, distal; with formation of intestinal pouch

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,398.83 / $7,244.36 / $9,772.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,905.46 / $2,187.76 / $4,265.80
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,890.45 / $10,964.78 / $16,982.44
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,949.84 / $4,168.69 / $6,165.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $3,019.95 / $5,623.41
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Low / Median / High Price
$446.68 / $3,388.44 / $7,413.10
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,238.72 / $3,235.94 / $5,128.61
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$446.68 / $3,388.44 / $7,413.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,089.30 / $3,162.28 / $5,754.40
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,548.82 / $2,089.30 / $2,630.27