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Pennsylvania rates for HCPCS 77053

Mammary Ductogram Or Galactogram Single

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$16.78 / $22.32 / $53.70
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$19.67 / $19.67 / $19.67
Martin's Point
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$16.78 / $31.38 / $54.87
Priority Health
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$19.67 / $19.67 / $19.67
UPMC Health Plan
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$16.92 / $16.92 / $19.01