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Tibial/Peroneal Intravascular Lithotripsy

Oregon 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

Rates data updated July 2026.

Facilitymedian $13,804 · 10th–90th $7,943$36,3080%10%10th90th$13,804Professionalmedian $10,965 · 10th–90th $79$10,9650%50%10th$10,965$100.0$500.0$2.0K$10.0K$50.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$7,943.28
Median
$10,964.78
Typical High
$18,620.87
Aetna
Setting
Professional
Modifier
Global
Typical Low
$10,964.78
Median
$10,964.78
Typical High
$10,964.78
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$13,182.57
Median
$13,182.57
Typical High
$13,182.57
Pacific Source
Setting
Facility
Modifier
Global
Typical Low
$10,471.29
Median
$10,471.29
Typical High
$26,915.35
Providence
Setting
Facility
Modifier
Global
Typical Low
$13,182.57
Median
$13,182.57
Typical High
$13,182.57
Providence
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$79.43
Typical High
$79.43
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$28,840.32
Median
$36,307.81
Typical High
$46,773.51
United
Setting
Facility
Modifier
Global
Typical Low
$11,748.98
Median
$34,673.69
Typical High
$48,977.88