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Wisconsin 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
$52.48 / $72.44 / $89.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.61 / $125.89 / $407.38
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$28.84 / $52.48 / $218.78
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$85.11 / $229.09 / $724.44
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$54.95 / $74.13 / $154.88
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $154.88 / $478.63
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$33.88 / $52.48 / $158.49
Anthem BCBS
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$151.36 / $234.42 / $707.95
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$66.07 / $102.33 / $316.23
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.81 / $81.28 / $213.80
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$91.20 / $107.15 / $169.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.65 / $239.88 / $416.87
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$38.02 / $79.43 / $141.25
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$72.44 / $162.18 / $275.42
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.21 / $213.80 / $288.40
DeanCare
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$63.10 / $72.44 / $97.72
DeanCare
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$281.84 / $316.23 / $426.58
DeanCare
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$123.03 / $141.25 / $190.55
Medica
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$158.49 / $158.49 / $158.49
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.65 / $186.21 / $660.69
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$37.15 / $64.57 / $218.78
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$70.79 / $123.03 / $446.68
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $85.11
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.82 / $234.42 / $354.81
Quartz
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$81.28 / $218.78 / $218.78
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $524.81 / $660.69
Quartz
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$30.90 / $177.83 / $218.78
Quartz
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$61.66 / $338.84 / $446.68
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.03 / $389.05 / $645.65
Security Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$89.13 / $104.71 / $162.18
Security Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$169.82 / $199.53 / $323.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.15 / $147.91 / $363.08
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$37.15 / $50.12 / $120.23
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$70.79 / $95.50 / $245.47