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Wisconsin 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
$8,243.00 / $8,243.00 / $17,823.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,895.24 / $10,895.24 / $10,895.24
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,080.00 / $17,505.00 / $23,937.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,650.00 / $14,999.00 / $24,101.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $85.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,650.00 / $14,566.00 / $19,562.00