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Wisconsin 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
$8,243.00 / $8,243.00 / $17,823.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18,028.12 / $18,028.12 / $18,028.12
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,123.00 / $18,187.00 / $24,019.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,650.00 / $16,461.00 / $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