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Washington 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
$4,425.00 / $13,222.56 / $27,982.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,895.24 / $10,895.24 / $10,895.24
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24,233.94 / $31,176.05 / $60,313.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17,940.16 / $17,940.16 / $17,940.16
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,258.49 / $36,656.73 / $91,892.90
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,481.81 / $26,624.00 / $79,999.20
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23,201.20 / $31,176.05 / $59,636.26
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,340.00 / $13,441.00 / $26,100.00