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South Dakota 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
$4,338.00 / $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
$19,670.59 / $19,670.59 / $22,949.03
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,571.00 / $6,571.00 / $6,571.00