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Wisconsin 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
$8,317.64 / $11,220.18 / $17,782.79
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
$10,000.00 / $13,803.84 / $21,877.62
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,943.28 / $13,803.84 / $22,908.68
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $58.88 / $85.11
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,912.51 / $13,803.84 / $17,782.79