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Alaska rates for HCPCS 76775

Ultrasound, retroperitoneal (eg, renal, aorta, nodes), real time with image documentation; limited

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$85.69 / $117.98 / $230.48
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.09 / $123.92 / $246.51
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$25.26 / $31.41 / $108.47
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$37.67 / $88.11 / $118.06
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.56 / $109.20 / $203.52
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$21.94 / $52.31 / $101.47
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$42.07 / $50.12 / $109.23
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.18 / $176.61 / $356.93
Moda Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$66.30 / $79.56 / $182.56
Moda Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$80.06 / $97.05 / $174.38
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$149.24 / $247.50 / $371.01
Premera BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$102.50 / $118.90 / $164.00
Premera BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$118.90 / $135.00 / $183.00
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.62 / $185.79 / $332.00
Providence
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$52.31 / $123.00 / $186.14
Providence
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$77.05 / $126.00 / $197.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.46 / $185.78 / $309.89
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$39.27 / $101.48 / $169.27
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$66.45 / $99.69 / $140.62