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South Dakota 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
$4,338.00 / $4,338.00 / $11,226.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,895.24 / $10,895.24 / $10,895.24
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,571.00 / $18,412.96 / $29,852.96
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,361.15 / $11,361.15 / $13,254.68
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,571.00 / $6,571.00 / $6,571.00