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Tennessee 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 / $208.93 / $478.63
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$28.18 / $38.90 / $173.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.48 / $95.50 / $302.00
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$28.18 / $53.70 / $147.91
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$48.98 / $147.91 / $660.69
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$42.66 / $56.23 / $131.83
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.07 / $85.11 / $147.91
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$23.99 / $32.36 / $61.66
Ambetter
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$97.72 / $117.49 / $194.98
Ambetter
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$37.15 / $48.98 / $95.50
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.98 / $97.72 / $173.78
BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$30.90 / $47.86 / $77.62
BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$46.77 / $72.44 / $117.49
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.13 / $138.04 / $229.09
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
$72.44 / $102.33 / $169.82
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$28.18 / $41.69 / $70.79
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$43.65 / $60.26 / $102.33
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$549.54 / $549.54 / $549.54
Lucent Health
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$204.17 / $204.17 / $204.17
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $707.95 / $707.95
Lucent Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$204.17 / $263.03 / $263.03
Lucent Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$338.84 / $446.68 / $446.68
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.13 / $95.50 / $95.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $97.72 / $158.49
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$30.20 / $39.81 / $64.57
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$46.77 / $58.88 / $97.72