go back

Pennsylvania 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
$1,412.54 / $5,495.41 / $8,709.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,445.44 / $22,908.68 / $22,908.68
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,585.78 / $38,018.94 / $52,480.75
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,023.29 / $4,786.30 / $8,511.38
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $5,011.87 / $22,908.68
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,454.71 / $5,495.41 / $35,481.34
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,011.87 / $5,011.87 / $5,011.87