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Utah rates for HCPCS 75803

Lymphangiography Extremity Only Bilateral Rs&I

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$456.30 / $456.30 / $2,547.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$456.30 / $1,180.48 / $2,774.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$264.77 / $1,994.07 / $6,312.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.75 / $355.80 / $528.47
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $56.08 / $545.66
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,326.29 / $3,082.38 / $4,425.20
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.79 / $462.65 / $565.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.58 / $1,690.80 / $2,789.82