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Illinois 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
$1,174.90 / $4,677.35 / $14,454.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.90 / $1,659.59 / $2,344.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,365.16 / $4,365.16 / $4,365.16
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.23 / $199.53 / $1,202.26
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,630.78 / $15,848.93 / $46,773.51
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,737.80 / $2,238.72 / $4,073.80