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South Dakota 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
$4,338.00 / $4,338.00 / $4,338.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23,029.85 / $23,029.85 / $23,029.85
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,357.00 / $38,920.44 / $63,101.79
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,630.04 / $11,630.04 / $13,568.38
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,357.00 / $5,357.00 / $5,357.00