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Montana rates for HCPCS 0333T

Visual evoked potential, screening of visual acuity, automated, with report

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.15 / $73.36 / $79.93
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$105.16 / $105.16 / $105.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.39 / $89.39 / $106.25
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.73 / $79.73 / $105.16
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.39 / $91.05 / $106.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.00 / $116.00 / $126.76