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South Dakota 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
$261.23 / $261.23 / $261.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$195.53 / $232.72 / $377.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$383.21 / $468.99 / $586.24
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$232.72 / $350.53 / $524.22
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$211.28 / $387.63 / $1,509.85
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$356.76 / $502.21 / $544.62
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$350.26 / $395.75 / $619.71
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$289.45 / $373.35 / $437.39
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$821.00 / $821.00 / $821.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$211.28 / $384.14 / $490.55
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$329.50 / $387.70 / $403.20