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Michigan 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
$4,897.79 / $4,897.79 / $6,918.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.93 / $1,778.28 / $2,290.87
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$218,776.16 / $218,776.16 / $218,776.16
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29,512.09 / $218,776.16 / $218,776.16
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,238.72 / $5,623.41 / $6,918.31
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $1,862.09 / $2,754.23
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,187.76 / $15,488.17 / $25,118.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,819.70 / $2,137.96 / $2,884.03