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Idaho rates for HCPCS 0061U

Transcutaneous measurement of five biomarkers (tissue oxygenation [StO2], oxyhemoglobin [ctHbO2], deoxyhemoglobin [ctHbR], papillary and reticular dermal hemoglobin concentrations [ctHb1 and ctHb2]), using spatial frequency domain imaging (SFDI) and multi-spectral analysis

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.29 / $45.29 / $65.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.07 / $24.35 / $28.87
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.57 / $52.22 / $97.92
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.59 / $30.20 / $51.89
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.10 / $25.10 / $30.12
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.65 / $50.20 / $90.36
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.71 / $37.31 / $44.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.54 / $11.70 / $27.85