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Hawaii rates for HCPCS C9764

Revascularization, endovascular, open or percutaneous, lower extremity artery(ies), except tibial/peroneal; with intravascular lithotripsy, includes angioplasty within the same vessel(s), when performed

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,924.00 / $5,484.00 / $6,718.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,028.00 / $3,028.00 / $3,028.00
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,022.20 / $12,599.00 / $22,500.00