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Wisconsin 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
$8,466.00 / $9,245.00 / $17,823.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15,815.07 / $15,815.07 / $15,815.07
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,123.00 / $18,187.00 / $24,019.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,650.00 / $15,815.07 / $24,101.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $85.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,650.00 / $14,566.00 / $19,562.00