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Pennsylvania 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
$1,513.56 / $7,244.36 / $11,220.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.90 / $1,621.81 / $2,290.87
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,011.87 / $8,511.38 / $77,624.71
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $676.08 / $676.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,445.44 / $1,445.44 / $1,445.44
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $489.78 / $489.78
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,288.25 / $5,754.40 / $11,220.18
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $1,621.81 / $2,454.71
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,818.38 / $2,818.38 / $2,818.38
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,311.31 / $12,302.69 / $30,199.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,584.89 / $2,089.30 / $3,467.37