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Michigan rates for HCPCS 75803

Lymphangiography, extremity only, bilateral, radiological supervision and interpretation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,621.81 / $1,659.59 / $1,659.59
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $1,258.93 / $1,862.09
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,548.82 / $2,398.83 / $4,073.80
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $81.28 / $87.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$117.49 / $389.05 / $501.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.93 / $323.59 / $741.31
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$229.09 / $575.44 / $2,570.40
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.80 / $354.81 / $1,659.59
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$117.49 / $389.05 / $501.19
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.53 / $269.15 / $575.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$288.40 / $1,412.54 / $4,168.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.42 / $1,096.48 / $2,041.74