Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.
Original text from hospital filings
REVASC LITHOTRIP TIBI/PERONE
Suffern, NY
See all hospitals reporting HCPCS C9772 →Price type
Good Samaritan Hospital’s median price of $14.7k is 14% above the median hospital's median price ($12.8k), higher than 63% of the 1,715 hospitals reporting HCPCS C9772. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 7 payers, 13 plan rates. A facility fee, a professional fee, a per diem and a case rate are different bills, so each is listed on its own. Open a payer to see it across hospitals.
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| # | |||||||
|---|---|---|---|---|---|---|---|
| 1 | Aetna aetna hp network facility · case rate · outpatient | $9.9k | $9.9k | — | — | — | $9.9k – $9.9k |
| 2 | Aetna aetna facility · case rate · outpatient | $11.0k | $11.0k | — | — | — | $11.0k – $11.0k |
| 3 | Aetna aetna employee facility · case rate · outpatient | $11.0k | $11.0k | — | — | — | $11.0k – $11.0k |
| 4 | UnitedHealthcare uhc exchange facility · case rate · outpatient | $12.5k | $12.5k | — | — | — | $12.5k – $12.5k |
| 5 | Blue Cross Blue Shield blue cross connection/exchange facility · case rate · outpatient | $13.0k | $13.0k | — | — | — | $13.0k – $13.0k |
| 6 | Medicare medicare facility · fee schedule · outpatient | $14.4k | $14.4k | — | — | — | $14.4k – $14.4k |
| 7 | UnitedHealthcare uhc commercial facility · case rate · outpatient | $14.7k | $14.7k | — | — | — | $14.7k – $14.7k |
| 8 | UnitedHealthcare uhc empire facility · case rate · outpatient | $14.7k | $14.7k | — | — | — | $14.7k – $14.7k |
| 9 | Molina affinity by molina mcr facility · fee schedule · outpatient | $15.1k | $15.1k | — | — | — | $15.1k – $15.1k |
| 10 | Blue Cross Blue Shield blue cross small group facility · case rate · outpatient | $15.6k | $15.6k | — | — | — | $15.6k – $15.6k |
| 11 | Cigna cigna ppo facility · case rate · outpatient | $15.7k | $15.7k | — | — | — | $15.7k – $15.7k |
| 12 | Blue Cross Blue Shield blue cross hmo facility · case rate · outpatient | $16.0k | $16.0k | — | — | — | $16.0k – $16.0k |
| 13 | Tricare tricare facility · fee schedule · outpatient | $50k | $50k | — | — | — | $50k – $50k |
Last updated: Jun 29, 2026
See Lithotripsy-assisted angioplasty of leg artery pricing across every hospital in the network reporting it, or ask Claude or any MCP client directly — see how to connect.