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Utah rates for HCPCS 0472T

Device evaluation, interrogation, and initial programming of intraocular retinal electrode array (eg, retinal prosthesis), in person, with iterative adjustment of the implantable device to test functionality, select optimal permanent programmed values with analysis, including visual training, with review and report by a qualified health care professional

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.99 / $48.99 / $48.99
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.99 / $48.99 / $114.92
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $45.00 / $60.00
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$404.12 / $574.87 / $825.31
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.19 / $73.54 / $302.97
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.16 / $81.06 / $310.60