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Utah 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
$213.80 / $213.80 / $213.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.97 / $234.42 / $331.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.17 / $251.19 / $380.19
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $549.54
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$295.12 / $346.74 / $758.58
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.42 / $275.42 / $331.13
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.53 / $302.00 / $416.87
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.04 / $316.23 / $426.58
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
$162.18 / $218.78 / $309.03