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Ohio 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
$4,168.69 / $9,332.54 / $12,302.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.93 / $1,778.28 / $8,912.51
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,162.28 / $8,511.38 / $60,255.96
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $1,096.48 / $1,949.84
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,290.87 / $29,512.09 / $51,286.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21,379.62 / $21,379.62 / $21,379.62
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21,379.62 / $21,379.62 / $21,379.62
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,511.38 / $8,511.38 / $8,511.38
SummaCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,019.95 / $3,467.37 / $6,606.93
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,000.00 / $26,302.68 / $47,863.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,659.59 / $2,238.72 / $4,786.30