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Idaho 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
$3,388.44 / $5,495.41 / $22,908.68
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22,908.68 / $22,908.68 / $22,908.68
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,549.93 / $22,387.21 / $34,673.69
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18,620.87 / $18,620.87 / $18,620.87
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,388.44 / $5,495.41 / $26,915.35
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,466.84 / $8,709.64 / $22,908.68
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $77.62
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,882.50 / $24,547.09 / $37,153.52
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18,620.87 / $26,302.68 / $29,512.09
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,748.98 / $26,915.35 / $29,512.09