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Virginia rates for HCPCS 43634

Gastrectomy, partial, distal; with formation of intestinal pouch

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,397.03 / $5,048.00 / $9,539.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,008.51 / $2,397.03 / $2,934.11
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,385.00 / $10,311.04 / $14,433.40
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,911.19 / $2,490.30 / $3,485.12
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,350.16 / $2,353.23 / $4,588.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$490.00 / $610.00 / $2,420.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,663.42 / $2,530.56 / $4,602.02
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,950.76 / $2,409.76 / $3,460.51
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,025.03 / $2,636.73 / $3,936.45
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,411.00 / $2,966.00 / $4,876.97
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,798.47 / $2,533.31 / $4,581.33
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,798.47 / $2,533.31 / $4,581.33
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$327.00 / $2,397.00 / $5,202.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,591.53 / $2,330.71 / $3,981.18