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Utah rates for HCPCS 76642

Ultrasound, breast, unilateral, real time with image documentation, including axilla when performed; limited

Facilitymedian $380 · 10th–90th $85$6460%10%10th90th$380Professionalmedian $83 · 10th–90th $32$3800%5%10%10th90th$83$10.0$20.0$50.0$100.0$200.0$500.0$1.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$85.11 / $407.38 / $660.69
Aetna
Facility/Professional
Facility
Modifier
26
Typical Low / Median / Typical High
$38.02 / $204.17 / $204.17
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$69.18 / $95.50 / $446.68
Aetna
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$30.20 / $60.26 / $128.82
Aetna
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$74.13 / $346.74 / $691.83
Aetna
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$44.67 / $58.88 / $257.04
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$70.79 / $112.20 / $724.44
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$87.10 / $117.49 / $177.83
Cigna
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$34.67 / $45.71 / $69.18
Cigna
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$51.29 / $67.61 / $107.15
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $77.62
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$125.89 / $181.97 / $302.00
Regence BlueShield
Facility/Professional
Facility
Modifier
26
Typical Low / Median / Typical High
$147.91 / $147.91 / $147.91
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $151.36 / $181.97
Regence BlueShield
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$44.67 / $60.26 / $74.13
Regence BlueShield
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$74.13 / $89.13 / $109.65
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $131.83 / $186.21
Select Health
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$30.90 / $51.29 / $75.86
Select Health
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$48.98 / $79.43 / $112.20
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$44.67 / $74.13 / $138.04
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $89.13 / $147.91
United
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$31.62 / $35.48 / $60.26
United
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$51.29 / $54.95 / $91.20