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Indiana 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
$1,621.81 / $4,897.79 / $17,378.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.90 / $1,548.82 / $2,398.83
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22,908.68 / $47,863.01 / $97,723.72
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $1,202.26 / $1,862.09
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,819.70 / $27,542.29 / $40,738.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$446.68 / $549.54 / $3,019.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,584.89 / $1,584.89 / $8,511.38
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,120.11 / $19,498.45 / $26,302.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,659.59 / $2,089.30 / $3,630.78