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Michigan rates for HCPCS C9775

Revascularization Endovascular Open Or Percutaneous Tibial/Peroneal Artery(Ies); With Intravascular Lithotripsy And Transluminal Stent Placement(S) And Atherectomy Includes Angioplastywithin The Same Vessel (S) When Performed

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,933.00 / $4,933.00 / $6,906.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13,029.00 / $17,383.00 / $22,584.00
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,933.00 / $4,933.00 / $6,906.00
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,933.00 / $4,933.00 / $13,029.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,850.00 / $11,464.00 / $15,011.00