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New Hampshire 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
$2,398.83 / $3,388.44 / $14,791.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22,908.68 / $22,908.68 / $22,908.68
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,912.51 / $10,000.00 / $18,197.01
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,302.69 / $12,302.69 / $12,302.69
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12,302.69 / $20,417.38 / $41,686.94
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,302.69 / $12,302.69 / $12,302.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14,454.40 / $17,378.01 / $40,738.03