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Utah rates for HCPCS 96571

Photodynamic therapy by endoscopic application of light to ablate abnormal tissue via activation of photosensitive drug(s); each additional 15 minutes (List separately in addition to code for endoscopy or bronchoscopy procedures of lung and gastrointestinal tract)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.90 / $3,388.44 / $6,025.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.89 / $25.70 / $64.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.51 / $36.31 / $51.29
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $52.48
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.18 / $35.48 / $41.69
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.91 / $38.90 / $54.95
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $37.15 / $54.95
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,071.52 / $4,466.84 / $5,128.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.44 / $32.36 / $46.77