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Montana rates for HCPCS 0378T

Visual field assessment, with concurrent real time data analysis and accessible data storage with patient initiated data transmitted to a remote surveillance center for up to 30 days; review and interpretation with report by a physician or other qualified health care professional

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.28 / $32.64 / $35.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.80 / $46.80 / $46.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.78 / $39.78 / $47.29
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.80 / $46.80 / $192.00
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.78 / $39.86 / $47.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.83 / $50.73 / $56.41