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Iowa 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
$85.11 / $208.93 / $562.34
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$28.84 / $42.66 / $66.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $114.82 / $457.09
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$30.20 / $69.18 / $190.55
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$75.86 / $229.09 / $707.95
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$43.65 / $61.66 / $281.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$275.42 / $281.84 / $295.12
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$107.15 / $109.65 / $114.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $204.17 / $251.19
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$37.15 / $75.86 / $93.33
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$56.23 / $125.89 / $158.49
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.18 / $213.80 / $257.04
Hally Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$33.11 / $97.72 / $134.90
Hally Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$51.29 / $100.00 / $128.82
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$81.28 / $181.97 / $371.54
Medica
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$109.65 / $147.91 / $147.91
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.18 / $138.04 / $549.54
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$33.11 / $43.65 / $204.17
Medica
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$331.13 / $363.08 / $416.87
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$46.77 / $64.57 / $338.84
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.96 / $181.97 / $218.78
Midlands
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$64.57 / $70.79 / $81.28
Midlands
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$100.00 / $112.20 / $134.90
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$295.12 / $295.12 / $295.12
Midlands
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$114.82 / $114.82 / $114.82
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.96 / $213.80 / $234.42
Midlands
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$64.57 / $81.28 / $89.13
Midlands
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$102.33 / $134.90 / $144.54
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$213.80 / $724.44 / $2,041.74
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.11 / $69.18 / $141.25
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$114.82 / $199.53 / $269.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.18 / $100.00 / $186.21
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$33.11 / $39.81 / $74.13
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$48.98 / $58.88 / $112.20
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.36 / $151.36 / $177.83
Wellmark
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$57.54 / $57.54 / $67.61
Wellmark
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$93.33 / $93.33 / $109.65