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Washington rates for HCPCS 0631T

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

Insurance Carrier
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.80 / $164.12 / $364.85
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.14 / $189.84 / $693.68
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.23 / $73.93 / $124.31
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$277.05 / $277.05 / $277.05
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $50.00 / $50.00
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$105.95 / $157.86 / $161.47
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$109.17 / $109.17 / $110.14
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.14 / $183.38 / $219.48
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$59.76 / $84.33 / $161.41
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.34 / $153.54 / $201.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.33 / $132.54 / $231.37
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$246.80 / $246.80 / $246.80