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Utah rates for HCPCS 75809

Shuntogram for investigation of previously placed indwelling nonvascular shunt (eg, LeVeen shunt, ventriculoperitoneal shunt, indwelling infusion pump), radiological supervision and interpretation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$26.35 / $26.35 / $26.35
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.95 / $105.81 / $165.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.17 / $120.35 / $189.80
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.85 / $58.93 / $77.63
Regence BlueShield
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$198.33 / $198.33 / $198.33
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$121.46 / $152.77 / $200.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.48 / $98.19 / $154.19