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Michigan rates for HCPCS C9758

Blind procedure for NYHA Class III/IV heart failure; transcatheter implantation of interatrial shunt including right heart catheterization, transesophageal echocardiography (TEE)/intracardiac echocardiography (ICE), and all imaging with or without guidance (e.g., ultrasound, fluoroscopy), performed in an approved investigational device exemption (IDE) study

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,797.00 / $4,797.00 / $4,933.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12,452.00 / $20,580.00 / $23,640.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,062.91 / $16,403.91 / $23,079.10
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,797.00 / $4,797.00 / $4,933.00
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,797.00 / $4,933.00 / $21,697.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,428.00 / $14,270.00 / $20,603.00