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Oregon 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
$97.72 / $288.40 / $512.86
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$44.67 / $70.79 / $89.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.61 / $114.82 / $446.68
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$30.20 / $67.61 / $173.78
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$69.18 / $251.19 / $691.83
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$42.66 / $61.66 / $281.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.54 / $239.88 / $302.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.13 / $162.18 / $239.88
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$36.31 / $60.26 / $93.33
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$54.95 / $102.33 / $151.36
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.25 / $177.83 / $218.78
Kaiser Permanente
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$51.29 / $66.07 / $77.62
Kaiser Permanente
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$91.20 / $112.20 / $141.25
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.13 / $151.36 / $398.11
Moda Health
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$44.67 / $63.10 / $87.10
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.13 / $169.82 / $269.15
Moda Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$34.67 / $66.07 / $107.15
Moda Health
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$67.61 / $169.82 / $724.44
Moda Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$58.88 / $107.15 / $154.88
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$125.89 / $165.96 / $173.78
Pacific Source
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$52.48 / $63.10 / $64.57
Pacific Source
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$38.90 / $54.95 / $67.61
Pacific Source
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$69.18 / $93.33 / $107.15
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.43 / $123.03 / $218.78
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.90 / $173.78 / $239.88
Providence
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$42.66 / $66.07 / $93.33
Providence
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$70.79 / $107.15 / $151.36
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$204.17 / $281.84 / $363.08
Regence BlueShield
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$208.93 / $208.93 / $208.93
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.88 / $181.97 / $229.09
Regence BlueShield
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$58.88 / $69.18 / $89.13
Regence BlueShield
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$95.50 / $112.20 / $144.54
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$263.03 / $323.59 / $426.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $100.00 / $223.87
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$33.11 / $37.15 / $87.10
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$52.48 / $60.26 / $138.04