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Montana rates for HCPCS 0379T

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; technical support and patient instructions, surveillance, analysis, and transmission of daily and emergent data reports as prescribed by a physician or other qualified health care professional

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.48 / $65.48 / $214.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.88 / $901.95 / $1,002.17
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$901.95 / $901.95 / $1,002.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.73 / $124.84 / $146.74