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South Carolina 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 / $512.86 / $954.99
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$27.54 / $35.48 / $48.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.23 / $104.71 / $407.38
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$28.18 / $56.23 / $144.54
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$47.86 / $158.49 / $707.95
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$41.69 / $52.48 / $120.23
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.10 / $77.62 / $147.91
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$24.55 / $30.90 / $54.95
Ambetter
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$114.82 / $117.49 / $229.09
Ambetter
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$39.81 / $45.71 / $53.70
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$117.49 / $218.78 / $380.19
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $85.11 / $117.49
BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$31.62 / $48.98 / $75.86
BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$20.42 / $47.86 / $67.61
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.29 / $257.04 / $446.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $109.65 / $165.96
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$30.90 / $43.65 / $67.61
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$48.98 / $64.57 / $102.33
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.79 / $100.00 / $199.53
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $33.11
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$81.28 / $363.08 / $562.34
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.79 / $89.13 / $158.49
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$28.18 / $35.48 / $63.10
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$43.65 / $54.95 / $95.50