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Michigan rates for HCPCS C9764

Revascularization Endovascular Open Or Percutaneous Any Vessel(S); With Intravascular Lithotripsy Includes Angioplasty Within The Same Vessel(S) When Performed

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,933.00 / $4,933.00 / $6,907.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16,643.00 / $22,206.00 / $28,850.00
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,933.00 / $4,933.00 / $6,907.00
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,933.00 / $4,933.00 / $16,643.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,000.00 / $10,192.00 / $14,705.00