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Utah 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
$50.12 / $66.07 / $79.43
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.13 / $89.13 / $95.50
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $44.67 / $60.26
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.18 / $85.11 / $100.00
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.20 / $1.20 / $1.20
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $77.62 / $77.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.54 / $67.61 / $93.33