go back

Wisconsin rates for HCPCS 77054

Mammary Ductogram Or Galactogram Multiple

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$103.47 / $144.91 / $200.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.09 / $73.47 / $144.91
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$141.00 / $246.00 / $493.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.76 / $155.84 / $423.82
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$204.51 / $232.40 / $293.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.64 / $243.93 / $277.19
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.20 / $103.47 / $173.12
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.20 / $103.47 / $348.36
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.25 / $187.66 / $678.50
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.07 / $58.40 / $123.82
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.20 / $103.47 / $173.12
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$135.19 / $202.55 / $294.95
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$165.70 / $348.36 / $348.36
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$113.01 / $355.20 / $678.50
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.89 / $177.89 / $177.89
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$157.29 / $434.65 / $434.65
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$385.04 / $385.04 / $385.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.06 / $177.60 / $362.24