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Minnesota 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
$208.93 / $426.58 / $741.31
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$30.90 / $33.11 / $56.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $100.00 / $398.11
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$30.20 / $66.07 / $181.97
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$66.07 / $190.55 / $707.95
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$43.65 / $58.88 / $186.21
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.04 / $309.03 / $660.69
BCBS
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$23.44 / $26.92 / $26.92
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.04 / $199.53 / $302.00
BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$53.70 / $77.62 / $117.49
BCBS
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$208.93 / $302.00 / $436.52
BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$85.11 / $131.83 / $190.55
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$199.53 / $323.59 / $776.25
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$26.30 / $102.33 / $281.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $158.49 / $257.04
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$37.15 / $60.26 / $95.50
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$58.88 / $100.00 / $162.18
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$245.47 / $309.03 / $602.56
Health Partners
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$91.20 / $114.82 / $223.87
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.82 / $128.82 / $204.17
Health Partners
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$47.86 / $47.86 / $75.86
Health Partners
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$81.28 / $81.28 / $128.82
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.23 / $302.00 / $537.03
Medica
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$147.91 / $147.91 / $147.91
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.13 / $245.47 / $446.68
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$41.69 / $87.10 / $181.97
Medica
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$288.40 / $407.38 / $630.96
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$51.29 / $100.00 / $338.84
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$218.78 / $223.87 / $302.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $151.36 / $257.04
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$34.67 / $57.54 / $100.00
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$53.70 / $95.50 / $162.18