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Nebraska 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
$56.23 / $79.43 / $234.42
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.29 / $89.13 / $354.81
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$23.44 / $47.86 / $141.25
Aetna
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$57.54 / $100.00 / $446.68
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$25.12 / $48.98 / $131.83
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.65 / $46.77 / $141.25
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$20.42 / $32.36 / $61.66
Ambetter
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$22.91 / $22.91 / $56.23
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.72 / $104.71 / $109.65
BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$46.77 / $50.12 / $52.48
BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$51.29 / $56.23 / $128.82
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$151.36 / $151.36 / $151.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.71 / $125.89 / $199.53
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$21.88 / $52.48 / $77.62
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$23.99 / $67.61 / $125.89
Medica
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$123.03 / $123.03 / $123.03
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.13 / $117.49 / $446.68
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$30.90 / $47.86 / $263.03
Medica
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$56.23 / $56.23 / $56.23
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$54.95 / $74.13 / $398.11
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.65 / $125.89 / $199.53
Midlands
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$52.48 / $60.26 / $91.20
Midlands
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$56.23 / $66.07 / $134.90
Midlands
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$151.36 / $151.36 / $151.36
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $138.04 / $141.25
Midlands
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$43.65 / $52.48 / $64.57
Midlands
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$64.57 / $87.10 / $93.33
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.84 / $56.23 / $125.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.13 / $112.20 / $181.97
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$30.90 / $42.66 / $66.07
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$54.95 / $63.10 / $114.82