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Wisconsin rates for HCPCS 0333T

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.55 / $41.55 / $41.55
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.55 / $62.53 / $68.06
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.91 / $119.31 / $231.77
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.39 / $89.78 / $146.33
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.90 / $48.61 / $95.14
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.90 / $52.17 / $138.72
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.00 / $88.01 / $213.71
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $58.40 / $70.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.90 / $48.61 / $95.14
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.00 / $152.54 / $216.36
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$133.19 / $138.72 / $302.75
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$284.13 / $284.13 / $430.27
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.38 / $83.23 / $173.74