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New Hampshire 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
$100.00 / $100.00 / $9,859.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,992.79 / $9,992.00 / $19,050.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26,762.50 / $42,720.46 / $60,146.16
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,629.00 / $12,629.00 / $12,629.00
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,500.00 / $2,750.00 / $3,500.00