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Maine 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
$25.12 / $25.12 / $40.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.14 / $19.05 / $23.99
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.55 / $28.84 / $87.10
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.00 / $16.22 / $52.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.54 / $57.54 / $57.54
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.12 / $25.12 / $30.20
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.12 / $25.12 / $25.12
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.20 / $19.95 / $25.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.14 / $16.60 / $40.74