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New Hampshire 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
Facility
Modifier
Low / Median / High Price
$100.00 / $1,749.77 / $9,859.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$260.02 / $329.89 / $353.45
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$160.63 / $208.62 / $218.87
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$409.77 / $654.26 / $1,149.78
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,448.00 / $7,448.00 / $7,448.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$372.52 / $500.02 / $911.35
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,500.00 / $2,750.00 / $3,500.00