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Montana 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
Professional
Modifier
Low / Median / High Price
$15,488.17 / $15,488.17 / $15,488.17
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46,773.51 / $81,283.05 / $95,499.26
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52,480.75 / $52,480.75 / $52,480.75
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52,480.75 / $52,480.75 / $52,480.75
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19,498.45 / $19,498.45 / $19,498.45
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $79.43 / $85.11