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Washington 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
$4,466.84 / $13,182.57 / $28,183.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15,488.17 / $15,488.17 / $15,488.17
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29,512.09 / $29,512.09 / $29,512.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,000.00 / $10,000.00 / $10,000.00
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16,218.10 / $75,857.76 / $134,896.29
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,220.18 / $42,657.95 / $42,657.95
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35,481.34 / $50,118.72 / $95,499.26
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,511.38 / $64,565.42 / $109,647.82