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Virginia 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
$2,187.76 / $6,456.54 / $15,488.17
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.93 / $1,905.46 / $2,454.71
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,882.50 / $22,387.21 / $38,018.94
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.93 / $1,778.28 / $2,454.71
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,370.32 / $15,848.93 / $18,197.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,511.38 / $8,511.38 / $8,511.38
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,621.81 / $1,905.46 / $2,398.83
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,445.44 / $2,187.76 / $3,388.44
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,778.28 / $3,162.28 / $50,118.72
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,778.28 / $3,162.28 / $50,118.72
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26,302.68 / $54,954.09 / $114,815.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,288.25 / $1,819.70 / $3,235.94