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Wisconsin rates for HCPCS 77053

Mammary Ductogram Or Galactogram Single

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$25.73 / $35.72 / $35.72
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$47.84 / $54.36 / $69.98
Medica
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$80.00 / $80.00 / $80.00
Quartz
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$40.88 / $80.00 / $80.00