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New Hampshire rates for HCPCS 77054

Mammary ductogram or galactogram, multiple ducts, radiological supervision and interpretation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$371.54 / $371.54 / $371.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.54 / $72.44 / $141.25
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$309.03 / $380.19 / $426.58
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.18 / $109.65 / $154.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$275.42 / $691.83 / $1,412.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.13 / $144.54 / $229.09
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $123.03 / $181.97
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $120.23 / $208.93
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$53.70 / $53.70 / $53.70