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Nebraska 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
$17.75 / $17.75 / $17.75
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.57 / $16.57 / $18.30
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.08 / $71.12 / $137.58
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.00 / $40.50 / $41.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.12 / $45.70 / $57.12
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.06 / $29.00 / $119.23
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.06 / $15.06 / $80.48
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.12 / $51.71 / $80.90
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.12 / $54.06 / $64.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.54 / $15.06 / $16.71