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Tibial/Peroneal Intravascular Lithotripsy

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

Rates data updated July 2026.

Facilitymedian $6,607 · 10th–90th $4,365$18,6210%20%40%10th90th$6,607Professionalmedian $10,965 · 10th–90th $10,965$10,9650%50%100%$10,965$5.0K$10.0K$20.0K

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

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$4,365.16
Median
$4,365.16
Typical High
$11,220.18
Aetna
Setting
Professional
Modifier
Global
Typical Low
$10,964.78
Median
$10,964.78
Typical High
$10,964.78
Medica
Setting
Facility
Modifier
Global
Typical Low
$6,606.93
Median
$18,620.87
Typical High
$29,512.09
United
Setting
Facility
Modifier
Global
Typical Low
$6,606.93
Median
$6,606.93
Typical High
$6,606.93