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New Hampshire 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
$28.11 / $61.77 / $175.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.50 / $22.56 / $34.53
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.29 / $48.59 / $124.98
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.30 / $16.30 / $52.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.34 / $92.17 / $110.14
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.10 / $25.10 / $82.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.03 / $15.06 / $25.10
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.73 / $20.61 / $26.24