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South Dakota rates for HCPCS C9774

Revascularization Endovascular Open Or Percutaneous Tibial/Peroneal Artery(Ies); With Intravascular Lithotripsy And Atherectomy 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 / $4,338.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18,028.12 / $18,028.12 / $18,028.12
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,571.00 / $30,467.52 / $49,397.05
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17,823.29 / $17,823.29 / $20,793.83
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,571.00 / $6,571.00 / $6,571.00