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Virginia 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
$83.18 / $426.58 / $912.01
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$28.84 / $41.69 / $208.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.29 / $95.50 / $309.03
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$28.84 / $57.54 / $144.54
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$53.70 / $154.88 / $630.96
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$43.65 / $57.54 / $134.90
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$295.12 / $346.74 / $436.52
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.18 / $114.82 / $169.82
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$30.90 / $42.66 / $61.66
Anthem BCBS
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$123.03 / $173.78 / $257.04
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$50.12 / $70.79 / $104.71
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $95.50 / $208.93
CareFirst
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$30.90 / $34.67 / $41.69
CareFirst
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$51.29 / $54.95 / $70.79
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.82 / $234.42 / $524.81
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
$69.18 / $107.15 / $186.21
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$26.30 / $40.74 / $70.79
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$42.66 / $66.07 / $120.23
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $95.50 / $120.23
Kaiser Permanente
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$27.54 / $33.88 / $43.65
Kaiser Permanente
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$48.98 / $61.66 / $75.86
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $190.55 / $190.55
Medcost
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$69.18 / $69.18 / $69.18
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.13 / $109.65 / $165.96
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.66 / $61.66 / $138.04
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.90 / $74.13 / $165.96
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.74 / $95.50 / $223.87
Sentara
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$34.67 / $44.67 / $69.18
Sentara
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$53.70 / $69.18 / $107.15
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.71 / $89.13 / $186.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.61 / $89.13 / $154.88
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$25.70 / $34.67 / $58.88
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$42.66 / $57.54 / $97.72