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South Dakota 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
$22.91 / $22.91 / $28.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.85 / $19.05 / $28.18
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.86 / $47.86 / $47.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $47.86 / $60.26
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.98 / $28.18 / $41.69
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.13 / $15.14 / $125.89
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $30.20
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $58.88 / $69.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.47 / $15.14 / $41.69
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.12 / $25.12 / $25.12