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Vermont 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 / $19.95 / $33.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.69 / $41.69 / $41.69
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.12 / $25.12 / $25.12
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.12 / $25.12 / $25.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.47 / $15.14 / $57.54