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Louisiana 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
$77.62 / $245.47 / $426.58
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$37.15 / $41.69 / $47.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.02 / $89.13 / $190.55
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$28.18 / $50.12 / $112.20
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$47.86 / $104.71 / $309.03
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$39.81 / $56.23 / $97.72
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $67.61 / $112.20
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$24.55 / $32.36 / $51.29
Ambetter
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$97.72 / $125.89 / $173.78
Ambetter
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$37.15 / $42.66 / $53.70
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.43 / $128.82 / $181.97
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.13 / $104.71 / $141.25
BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$35.48 / $41.69 / $58.88
BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$53.70 / $63.10 / $83.18
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.57 / $64.57 / $81.28
Christus
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$30.20 / $33.88 / $33.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.72 / $181.97 / $245.47
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.54 / $87.10 / $162.18
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$22.91 / $35.48 / $64.57
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$33.11 / $50.12 / $95.50
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.07 / $138.04 / $208.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.07 / $89.13 / $138.04
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$25.70 / $33.88 / $52.48
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$38.90 / $51.29 / $81.28