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Montana rates for HCPCS 96573

Photodynamic therapy by external application of light to destroy premalignant lesions of the skin and adjacent mucosa with application and illumination/activation of photosensitizing drug(s) provided by a physician or other qualified health care professional, per day

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$462.92 / $462.92 / $462.92
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$189.77 / $196.40 / $377.15
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64,999.99 / $77,999.99 / $94,999.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$303.91 / $357.54 / $357.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$357.54 / $357.54 / $425.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$198.16 / $314.79 / $395.78
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$212.83 / $257.69 / $357.54
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$225.48 / $338.25 / $446.78
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$228.89 / $228.89 / $228.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.35 / $349.74 / $382.18