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Michigan rates for HCPCS C9765

Revascularization, endovascular, open or percutaneous, lower extremity artery(ies), except tibial/peroneal; with intravascular lithotripsy, and transluminal stent placement(s), includes angioplasty within the same vessel(s), when performed

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,933.00 / $4,933.00 / $6,906.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25,226.00 / $33,657.00 / $43,728.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,937.73 / $9,937.73 / $9,937.73
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,933.00 / $4,933.00 / $6,906.00
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,933.00 / $4,933.00 / $25,226.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,850.00 / $11,464.00 / $15,011.00