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Idaho 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
$4,786.30 / $5,495.41 / $6,918.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.90 / $1,513.56 / $2,818.38
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,737.80 / $3,019.95 / $9,772.37
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,819.70 / $2,238.72 / $2,344.23
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,202.26 / $1,737.80 / $5,495.41
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.90 / $1,513.56 / $1,949.84
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $77.62
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,884.03 / $2,884.03 / $4,570.88
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,290.87 / $3,090.30 / $3,235.94
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,754.40 / $7,943.28 / $17,782.79
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,128.61 / $14,454.40 / $51,286.14
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,819.70 / $2,511.89 / $3,630.78