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Pennsylvania rates for HCPCS 0577T

Electrophysiologic evaluation of implantable cardioverter-defibrillator system with substernal electrode (includes defibrillation threshold evaluation, induction of arrhythmia, evaluation of sensing for arrhythmia termination, and programming or reprogramming of sensing or therapeutic parameters)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$198.89 / $3,839.00 / $8,247.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$167.19 / $205.01 / $276.22
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,167.88 / $2,232.58 / $2,878.86
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$266.64 / $266.64 / $266.64
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$657.00 / $4,761.00 / $8,247.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$167.19 / $212.82 / $1,544.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.00 / $7.00 / $7.00
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,167.88 / $1,299.33 / $2,397.09
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$204.58 / $204.58 / $217.12
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.58 / $215.27 / $217.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$196.95 / $250.67 / $385.48