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Michigan rates for HCPCS C9772

Revascularization Endovascular Open Or Percutaneous Tibial/Peroneal Artery(Ies) With Intravascular Lithotripsy Includes Angioplasty Within The Same Vessel (S) When Performed

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,933.00 / $4,933.00 / $6,906.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,874.00 / $10,505.00 / $13,649.00
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,933.00 / $4,933.00 / $6,906.00
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,933.00 / $4,933.00 / $7,874.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,850.00 / $11,464.00 / $15,011.00