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Utah rates for HCPCS 96913

Photochemotherapy (Goeckerman and/or PUVA) for severe photoresponsive dermatoses requiring at least 4-8 hours of care under direct supervision of the physician (includes application of medication and dressings)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.04 / $138.04 / $138.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.49 / $154.88 / $213.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.71 / $173.78 / $234.42
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $213.80
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$575.44 / $676.08 / $1,584.89
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.96 / $190.55 / $213.80
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.90 / $204.17 / $281.84
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $208.93 / $263.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.65 / $141.25 / $208.93