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Vermont 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 / $977.24 / $1,000.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.18 / $117.49 / $354.81
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$25.70 / $69.18 / $128.82
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$104.71 / $190.55 / $562.34
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$42.66 / $61.66 / $177.83
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.87 / $602.56 / $912.01
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $102.33 / $120.23
BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$38.90 / $38.90 / $134.90
BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$63.10 / $63.10 / $75.86
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$218.78 / $676.08 / $676.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.10 / $123.03 / $363.08
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$22.91 / $46.77 / $134.90
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$40.74 / $75.86 / $162.18
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $89.13 / $363.08
MVP Health Care
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$33.11 / $35.48 / $134.90
MVP Health Care
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$54.95 / $54.95 / $64.57
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.13 / $107.15 / $229.09
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$33.88 / $39.81 / $89.13
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$51.29 / $63.10 / $134.90