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Montana 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
Professional
Modifier
Low / Median / High Price
$19.05 / $22.91 / $23.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.31 / $36.31 / $36.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.31 / $36.31 / $36.31
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.12 / $38.02 / $75.86
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.12 / $38.02 / $75.86
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.62 / $25.70 / $48.98
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.39 / $36.31 / $79.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.47 / $10.47 / $25.12