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Pennsylvania rates for HCPCS 75801

Lymphangiography Extremity Only Unilateral Rs&I

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$41.14 / $53.95 / $131.65
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$48.31 / $48.31 / $48.31
Martin's Point
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$41.14 / $76.93 / $134.53
Priority Health
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$27.73 / $48.31 / $48.31
UPMC Health Plan
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$41.25 / $41.25 / $44.00