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Indiana 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
$1,380.38 / $4,897.79 / $14,125.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $22,908.68 / $22,908.68
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,232.93 / $25,703.96 / $35,481.34
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,471.29 / $10,471.29 / $10,471.29
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,128.61 / $11,220.18 / $17,378.01