| Name | Value |
|---|---|
| NAME | LYMPHANGIOGRAM EXTREMITY BILAT CP |
| PACKAGE NAME | LYMPHANGIOGRAM EXTREMITY BILAT CP |
| ID | 352;99RAP |
| CODE | 75804 |
| CODING SYSTEM | CPT4 |
| DISPLAY GROUP | IMAGING |
| AUTHORIZATION | PHYSICIAN |
| PROCEDURE TYPE | DETAILED |
| IMAGING TYPE | RADIOLOGY |
| COMMON PROCEDURE | NO |
| SET MEMBERSHIP |
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