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Pennsylvania 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
$1,426.00 / $6,432.00 / $10,805.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16,737.61 / $16,737.61 / $16,737.61
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,232.22 / $4,966.00 / $7,278.00
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,301.00 / $7,175.00 / $12,181.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$700.00 / $6,832.00 / $16,737.61
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,388.03 / $4,966.00 / $7,278.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,742.00 / $8,870.00 / $20,021.00