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Montana rates for HCPCS 92081

Visual field examination, unilateral or bilateral, with interpretation and report; limited examination (eg, tangent screen, Autoplot, arc perimeter, or single stimulus level automated test, such as Octopus 3 or 7 equivalent)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.88 / $46.66 / $72.73
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$17.38 / $20.84 / $35.83
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$12.54 / $25.82 / $51.18
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.71 / $24.71 / $52.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.69 / $26.69 / $52.58
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$24.71 / $24.71 / $24.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.15 / $47.32 / $53.13
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$18.23 / $22.24 / $24.97
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$18.89 / $24.74 / $28.16
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.10 / $38.22 / $69.43
Providence
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$24.71 / $24.71 / $24.71
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.38 / $47.07 / $61.88
Providence
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$20.52 / $22.24 / $24.80
Providence
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$21.26 / $24.74 / $27.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.66 / $55.67 / $79.80
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$22.54 / $25.76 / $30.15
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$22.11 / $28.43 / $45.65