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Utah rates for HCPCS 75803

Lymphangiography, extremity only, bilateral, radiological supervision and interpretation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$457.09 / $4,786.30 / $4,786.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $1,412.54 / $2,570.40
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$263.03 / $1,995.26 / $6,309.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $338.84 / $524.81
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $501.19
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,570.40 / $4,466.84 / $5,754.40
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $467.74 / $602.56
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.07 / $95.50 / $257.04
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $257.04 / $398.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.15 / $1,380.38 / $2,818.38