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New Hampshire rates for HCPCS 0100T

Placement of a subconjunctival retinal prosthesis receiver and pulse generator, and implantation of intra-ocular retinal electrode array, with vitrectomy

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,398.83 / $5,370.32 / $22,387.21
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,318.26 / $1,995.26 / $2,818.38
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,964.78 / $12,022.64 / $22,908.68
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,548.82 / $1,548.82 / $1,548.82
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,589.25 / $12,589.25 / $12,589.25
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,041.74 / $3,311.31 / $5,370.32
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,589.25 / $12,589.25 / $12,589.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,041.74 / $2,818.38 / $5,370.32