go back

Utah rates for HCPCS 76641

Ultrasound, breast, unilateral, real time with image documentation, including axilla when performed; complete

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$40.74 / $40.74 / $40.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $109.65 / $416.87
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$30.20 / $40.74 / $109.65
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$46.77 / $234.42 / $741.31
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$56.23 / $70.79 / $134.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $138.04 / $204.17
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$33.88 / $48.98 / $72.44
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$64.57 / $89.13 / $134.90
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $102.33
Regence BlueShield
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$199.53 / $199.53 / $199.53
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.54 / $186.21 / $223.87
Regence BlueShield
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$47.86 / $66.07 / $79.43
Regence BlueShield
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$95.50 / $123.03 / $144.54
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.50 / $158.49 / $229.09
Select Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$33.11 / $54.95 / $81.28
Select Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$63.10 / $102.33 / $147.91
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $104.71 / $173.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $109.65 / $181.97
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$34.67 / $37.15 / $61.66
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$67.61 / $72.44 / $120.23