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New Hampshire 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
$2,398.83 / $3,388.44 / $14,791.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15,488.17 / $15,488.17 / $15,488.17
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,332.54 / $10,471.29 / $19,952.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,000.00 / $10,000.00 / $10,000.00
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,589.25 / $12,589.25 / $12,589.25
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25,703.96 / $40,738.03 / $63,095.73
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,589.25 / $12,589.25 / $12,589.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29,512.09 / $35,481.34 / $61,659.50