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Utah rates for HCPCS 95875

Ischemic Limb Xers Tst Spec Acquisj Metab

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.49 / $126.58 / $153.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.05 / $159.41 / $253.60
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.93 / $65.67 / $98.49
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$140.00 / $182.09 / $251.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.60 / $151.19 / $205.84