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Pennsylvania rates for HCPCS 0474T

Insertion of anterior segment aqueous drainage device, with creation of intraocular reservoir, internal approach, into the supraciliary space

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$768.00 / $3,748.00 / $8,017.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$258.42 / $366.99 / $573.35
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$678.00 / $678.00 / $678.00
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$443.49 / $443.49 / $571.89
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$954.00 / $3,964.00 / $8,017.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.63 / $402.86 / $3,748.00
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$678.00 / $678.00 / $678.00
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$371.08 / $371.08 / $371.08
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.08 / $378.50 / $869.45
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,843.00 / $3,742.00 / $7,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$254.91 / $348.56 / $566.41