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Pennsylvania 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
$24.55 / $52.48 / $91.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.98 / $89.13 / $407.38
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$23.44 / $41.69 / $109.65
Aetna
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$42.66 / $83.18 / $371.54
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$25.12 / $47.86 / $134.90
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $48.98 / $83.18
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$10.23 / $26.30 / $44.67
Ambetter
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$13.49 / $13.49 / $13.49
Ambetter
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$22.39 / $27.54 / $38.02
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.23 / $56.23 / $158.49
Capital Blue Cross
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$26.92 / $32.36 / $63.10
Capital Blue Cross
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$29.51 / $38.02 / $107.15
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$6.61 / $30.90 / $44.67
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.70 / $89.13 / $151.36
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$20.89 / $32.36 / $53.70
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$28.84 / $57.54 / $100.00
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.44 / $85.11 / $102.33
Emblem Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$23.99 / $37.15 / $45.71
Emblem Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$29.51 / $45.71 / $57.54
Geisinger
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.88 / $81.28 / $128.82
Geisinger
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$24.55 / $34.67 / $56.23
Geisinger
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$34.67 / $46.77 / $83.18
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $70.79 / $75.86
Highmark BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$15.49 / $31.62 / $45.71
Highmark BCBS
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$33.11 / $33.11 / $33.11
Martin's Point
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$24.55 / $48.98 / $89.13
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.29 / $91.20 / $218.78
Martin's Point
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$23.44 / $37.15 / $83.18
Martin's Point
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$46.77 / $85.11 / $354.81
Martin's Point
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$26.30 / $53.70 / $117.49
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.95 / $109.65 / $173.78
UPMC Health Plan
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$27.54 / $27.54 / $30.20
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.88 / $48.98 / $85.11
UPMC Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$26.30 / $27.54 / $30.20
UPMC Health Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$27.54 / $27.54 / $50.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.66 / $81.28 / $131.83
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$21.88 / $29.51 / $48.98
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$36.31 / $51.29 / $89.13