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California rates for HCPCS 76642

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.23 / $446.68 / $870.96
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$30.90 / $40.74 / $85.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.88 / $114.82 / $446.68
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$30.20 / $63.10 / $169.82
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$74.13 / $218.78 / $660.69
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$45.71 / $67.61 / $309.03
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.61 / $89.13 / $194.98
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$26.92 / $47.86 / $75.86
Ambetter
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$109.65 / $125.89 / $338.84
Ambetter
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$37.15 / $81.28 / $102.33
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.74 / $44.67 / $446.68
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.15 / $154.88 / $281.84
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$38.90 / $56.23 / $100.00
Anthem BCBS
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$117.49 / $134.90 / $234.42
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$69.18 / $100.00 / $181.97
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.07 / $194.98 / $616.60
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $134.90 / $257.04
Blue Shield
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$35.48 / $50.12 / $95.50
Blue Shield
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$58.88 / $87.10 / $165.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$109.65 / $263.03 / $524.81
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$7.94 / $37.15 / $52.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $114.82 / $213.80
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$28.84 / $43.65 / $81.28
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$47.86 / $72.44 / $144.54
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $109.65 / $147.91
Contra Costa Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$28.84 / $36.31 / $48.98
Contra Costa Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$48.98 / $72.44 / $97.72
HealthNet
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$67.61 / $67.61 / $67.61
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.28 / $102.33 / $194.98
Kaiser Permanente
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$31.62 / $42.66 / $70.79
Kaiser Permanente
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$57.54 / $81.28 / $141.25
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$549.54 / $549.54 / $549.54
Lucent Health
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$204.17 / $204.17 / $204.17
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.82 / $707.95 / $707.95
Lucent Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$204.17 / $263.03 / $263.03
Lucent Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$338.84 / $446.68 / $446.68
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.90 / $58.88 / $97.72
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.86 / $117.49 / $218.78
Providence
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$7.94 / $37.15 / $52.48
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $120.23 / $223.87
Providence
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$28.18 / $41.69 / $79.43
Providence
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$46.77 / $70.79 / $144.54
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $288.40 / $288.40
Sutter Health Plus
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$109.65 / $109.65 / $109.65
Sutter Health Plus
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$181.97 / $181.97 / $181.97
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $102.33 / $134.90
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.04 / $144.54 / $218.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.18 / $89.13 / $186.21
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$26.92 / $34.67 / $69.18
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$42.66 / $54.95 / $120.23