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Pennsylvania 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 / $223.87 / $489.78
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$28.84 / $57.54 / $112.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.98 / $102.33 / $426.58
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$28.84 / $56.23 / $151.36
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$67.61 / $181.97 / $660.69
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$42.66 / $61.66 / $269.15
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.10 / $67.61 / $85.11
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$25.70 / $38.90 / $60.26
Ambetter
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$85.11 / $100.00 / $117.49
Ambetter
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$37.15 / $43.65 / $114.82
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,011.87 / $8,511.38 / $77,624.71
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.20 / $104.71 / $158.49
Capital Blue Cross
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$35.48 / $40.74 / $64.57
Capital Blue Cross
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$134.90 / $158.49 / $239.88
Capital Blue Cross
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$54.95 / $63.10 / $95.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.57 / $141.25 / $223.87
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
$67.61 / $107.15 / $165.96
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$25.70 / $40.74 / $64.57
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$41.69 / $64.57 / $100.00
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $117.49 / $141.25
Emblem Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$26.92 / $42.66 / $51.29
Emblem Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$45.71 / $72.44 / $89.13
Geisinger
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $102.33 / $162.18
Geisinger
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$30.90 / $40.74 / $61.66
Geisinger
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$40.74 / $63.10 / $100.00
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$69.18 / $194.98 / $346.74
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.20 / $95.50 / $112.20
Highmark BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$36.31 / $38.90 / $56.23
Highmark BCBS
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$56.23 / $144.54 / $165.96
Highmark BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$67.61 / $67.61 / $93.33
Independence Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.50 / $1,380.38 / $2,398.83
Independence Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.54 / $144.54 / $144.54
Independence Blue Cross
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$33.88 / $33.88 / $54.95
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.10 / $223.87 / $501.19
Martin's Point
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$28.84 / $48.98 / $112.20
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.07 / $104.71 / $257.04
Martin's Point
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$28.84 / $47.86 / $102.33
Martin's Point
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$66.07 / $186.21 / $660.69
Martin's Point
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$44.67 / $64.57 / $131.83
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$323.59 / $338.84 / $457.09
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.86 / $63.10 / $158.49
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.67 / $53.70 / $93.33
UPMC Health Plan
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$32.36 / $38.02 / $38.02
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.67 / $77.62 / $117.49
UPMC Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$31.62 / $33.11 / $38.02
UPMC Health Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$48.98 / $51.29 / $56.23
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$131.83 / $245.47 / $309.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.18 / $91.20 / $144.54
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$26.92 / $36.31 / $56.23
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$41.69 / $56.23 / $91.20