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South Dakota rates for HCPCS C9767

Revascularization, endovascular, open or percutaneous, lower extremity artery(ies), except tibial/peroneal; with intravascular lithotripsy and transluminal stent placement(s), and atherectomy, 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 / $4,937.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15,815.07 / $15,815.07 / $15,815.07
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,571.00 / $26,727.47 / $43,333.29
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19,001.45 / $19,001.45 / $22,168.35
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,571.00 / $6,571.00 / $6,571.00