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Montana 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
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46,773.51 / $81,283.05 / $95,499.26
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32,359.37 / $32,359.37 / $32,359.37
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32,359.37 / $32,359.37 / $32,359.37
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29,512.09 / $29,512.09 / $29,512.09
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $79.43 / $85.11