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Maine 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
Professional
Modifier
Low / Median / High Price
$22,908.68 / $22,908.68 / $22,908.68
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70,794.58 / $70,794.58 / $70,794.58
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22,908.68 / $22,908.68 / $22,908.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21,379.62 / $21,379.62 / $70,794.58