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New Hampshire 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
$100.00 / $2,331.21 / $14,929.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,992.79 / $9,992.00 / $19,050.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20,577.08 / $32,814.03 / $47,756.96
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,629.00 / $12,629.00 / $12,629.00
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,937.21 / $5,430.93 / $6,912.09