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Massachusetts 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
$2,691.53 / $3,715.35 / $5,623.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22,908.68 / $22,908.68 / $22,908.68
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,570.40 / $6,165.95 / $15,488.17
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.18 / $4,897.79 / $9,772.37
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,570.40 / $6,918.31 / $15,488.17
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,000.00 / $24,547.09 / $33,884.42
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,019.95 / $6,918.31 / $15,488.17
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,570.40 / $7,244.36 / $20,892.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,549.93 / $12,302.69 / $30,902.95