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Montana rates for HCPCS 96910

Photochemotherapy; tar and ultraviolet B (Goeckerman treatment) or petrolatum and ultraviolet B

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.56 / $76.76 / $202.86
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
$159.11 / $187.18 / $187.18
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$187.18 / $187.18 / $222.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.50 / $159.10 / $188.17
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$108.35 / $135.44 / $187.18
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$116.98 / $165.07 / $228.57
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.54 / $190.23 / $207.88