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Virginia rates for HCPCS 77053

Mammary Ductogram Or Galactogram Single

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$15.25 / $27.74 / $65.70
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$19.67 / $19.67 / $19.67
Kaiser Permanente
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$15.37 / $18.98 / $22.87
Medcost
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$19.98 / $28.56 / $56.00