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South Dakota rates for HCPCS 75803

Lymphangiography, extremity only, bilateral, radiological supervision and interpretation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,577.48 / $1,577.48 / $1,577.48
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,424.82 / $1,424.82 / $1,577.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$550.41 / $686.49 / $858.12
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$132.25 / $2,040.77 / $2,665.94
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$668.69 / $1,599.97 / $3,125.45
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$111.42 / $519.84 / $2,934.79
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.41 / $550.41 / $3,339.26
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$306.62 / $306.62 / $306.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,265.08 / $1,927.34 / $3,125.45
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,769.10 / $3,257.70 / $3,257.70