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Michigan 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
$4,897.79 / $4,897.79 / $16,218.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22,908.68 / $22,908.68 / $22,908.68
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,897.79 / $4,897.79 / $16,218.10
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22,908.68 / $22,908.68 / $32,359.37
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,011.87 / $10,000.00 / $23,442.29