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Pennsylvania 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
Facility
Modifier
Low / Median / High Price
$851.14 / $5,754.40 / $8,511.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $870.96 / $1,047.13
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,011.87 / $8,511.38 / $77,624.71
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $870.96 / $1,412.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,445.44 / $1,445.44 / $1,445.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $691.83 / $831.76
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,348.96 / $1,348.96 / $1,348.96
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$851.14 / $4,265.80 / $8,317.64
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $812.83 / $1,047.13
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$812.83 / $851.14 / $851.14
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $851.14 / $912.01
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,344.23 / $4,897.79 / $12,882.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $954.99 / $1,548.82