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Alaska rates for HCPCS 75803

Lymphangiography, extremity only, bilateral, radiological supervision and interpretation

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,134.68 / $4,134.68 / $4,134.68
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,813.92 / $6,813.92 / $6,813.92
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$387.77 / $683.76 / $875.54
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72.76 / $72.76 / $5,912.59
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$254.03 / $254.03 / $362.90
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$937.50 / $1,021.80 / $1,687.43
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72.76 / $87.31 / $6,813.92
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.46 / $1,132.50 / $2,400,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$433.72 / $3,915.34 / $6,889.00