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Utah 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 / $134.90 / $177.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.14 / $19.95 / $25.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.38 / $21.88 / $69.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $30.20
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $60.26 / $60.26
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.12 / $45.71 / $131.83
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.38 / $22.39 / $31.62
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.38 / $17.38 / $25.12
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.95 / $21.88 / $37.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.47 / $11.75 / $15.14