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Utah rates for HCPCS 0631T

Transcutaneous visible light hyperspectral imaging measurement of oxyhemoglobin, deoxyhemoglobin, and tissue oxygenation, with interpretation and report, per extremity

Insurance Carrier
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $60.00
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.42 / $56.46 / $82.27
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.07 / $92.30 / $104.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.30 / $89.51 / $142.19