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Washington 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
$333.28 / $5,116.62 / $20,680.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$291.81 / $333.28 / $365.69
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$430.35 / $460.20 / $1,522.92
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$451.25 / $798.06 / $2,939.40
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$734.00 / $734.00 / $734.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$529.48 / $529.48 / $529.48
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,030.09 / $1,030.09 / $1,030.09
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.00 / $50.00 / $75.00
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$552.64 / $646.59 / $674.69
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$430.35 / $430.35 / $460.20
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$473.69 / $759.78 / $916.16
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$438.90 / $629.15 / $872.06
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$118.00 / $414.00 / $5,793.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$397.32 / $514.71 / $955.71