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Maine rates for HCPCS 0450T

Insertion of aqueous drainage device, without extraocular reservoir, internal approach, into the subconjunctival space; each additional device (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$315.27 / $315.27 / $401.15
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.64 / $218.87 / $273.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$712.05 / $712.05 / $712.05
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$414.67 / $479.77 / $736.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$315.27 / $315.27 / $315.27
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.58 / $446.85 / $558.55