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Montana rates for HCPCS 96921

Excimer Laser Tx Psoriasis 250-500 Sq Cm

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.18 / $169.25 / $254.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$112.00 / $112.00 / $320.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.20 / $146.00 / $300.13
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.52 / $157.91 / $287.95
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.20 / $164.93 / $328.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$256.94 / $292.89 / $320.06