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South Dakota 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
$4,338.00 / $4,338.00 / $4,338.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15,443.64 / $15,443.64 / $15,443.64
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,571.00 / $26,099.75 / $42,315.57
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18,745.88 / $18,745.88 / $21,870.19
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,571.00 / $6,571.00 / $6,571.00