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Wisconsin 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
$8,317.64 / $8,317.64 / $17,782.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15,488.17 / $15,488.17 / $33,113.11
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,882.50 / $18,197.01 / $28,840.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,000.00 / $10,000.00 / $19,952.62
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,511.38 / $15,488.17 / $23,988.33
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $58.88 / $85.11
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,000.00 / $10,000.00 / $10,000.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,709.64 / $16,982.44 / $22,387.21