| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Capital Blue Cross
| Facility | $8,850.00 | $16,455.00 | $36,032.05 | |
UPMC Health Plan
| Facility | $269.45 | $276.93 | $3,673.62 |
Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, each additional vessel; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed (List separately in addition to code for primary procedure)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Capital Blue Cross
| Facility | $8,850.00 | $16,455.00 | $36,032.05 | |
UPMC Health Plan
| Facility | $269.45 | $276.93 | $3,673.62 |