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Washington 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
$4,466.84 / $13,182.57 / $30,199.52
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22,908.68 / $22,908.68 / $22,908.68
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18,197.01 / $18,197.01 / $18,197.01
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,232.93 / $47,863.01 / $83,176.38
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,471.29 / $26,915.35 / $26,915.35
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20,417.38 / $30,902.95 / $60,255.96
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,677.35 / $40,738.03 / $69,183.10