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Maine rates for HCPCS 0253T

Insertion of anterior segment aqueous drainage device, without extraocular reservoir, internal approach, into the suprachoroidal space

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $758.58 / $977.24
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $1,023.29 / $1,288.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$707.95 / $707.95 / $707.95
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.93 / $1,548.82 / $2,570.40
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $912.01 / $977.24
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $1,380.38 / $2,290.87