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Wisconsin 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
$25.70 / $25.70 / $17,782.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.91 / $25.70 / $61.66
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,202.26 / $1,584.89 / $1,584.89
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.54 / $40.74 / $87.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.57 / $74.13 / $120.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.11 / $63.10 / $83.18
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.12 / $31.62 / $57.54
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.67 / $56.23 / $69.18
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.54 / $1,202.26 / $1,778.28
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.92 / $46.77 / $407.38
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $77.62
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.67 / $63.10 / $87.10
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.54 / $501.19 / $501.19
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.30 / $128.82 / $407.38
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.90 / $30.90 / $30.90
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.74 / $66.07 / $87.10
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,023.29 / $1,584.89 / $1,949.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.12 / $40.74 / $93.33