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Virginia 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
$363.08 / $3,235.94 / $8,317.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $331.13 / $398.11
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $181.97 / $245.47
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $457.09 / $467.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,584.89 / $1,584.89 / $1,584.89
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $371.54 / $478.63
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$257.04 / $363.08 / $549.54
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$316.23 / $676.08 / $10,000.00
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $676.08 / $10,000.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$229.09 / $1,202.26 / $2,454.71
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $331.13 / $575.44