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Montana rates for HCPCS 76604

Ultrasound, chest (includes mediastinum), real time with image documentation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$89.59 / $89.59 / $89.59
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.34 / $88.15 / $239.99
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$23.46 / $30.99 / $118.80
Aetna
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$46.46 / $228.44 / $490.00
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$53.64 / $63.28 / $91.93
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.06 / $42.06 / $89.91
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$42.06 / $42.06 / $52.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.67 / $106.36 / $172.69
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$27.40 / $42.06 / $56.38
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$47.85 / $71.89 / $110.12
Providence
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$42.06 / $42.06 / $52.00
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.99 / $107.95 / $173.57
Providence
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$31.94 / $42.06 / $46.06
Providence
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$47.85 / $71.89 / $103.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.48 / $84.81 / $142.02
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$27.57 / $29.59 / $51.97
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$50.89 / $56.78 / $89.37