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Utah 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
$2,041.74 / $6,025.60 / $10,232.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.90 / $1,778.28 / $2,041.74
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $44.67 / $60.26
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,621.81 / $1,905.46 / $275,422.87
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,778.28 / $2,570.40 / $2,951.21
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.20 / $1.20 / $1.20
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,238.72 / $2,398.83 / $2,754.23
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,466.84 / $7,413.10 / $43,651.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,584.89 / $1,905.46 / $3,235.94