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Utah rates for HCPCS 76873

Ultrasound, transrectal; prostate volume study for brachytherapy treatment planning (separate procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$85.11 / $85.11 / $85.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.54 / $181.97 / $354.81
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$61.66 / $79.43 / $194.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.49 / $218.78 / $331.13
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$70.79 / $102.33 / $158.49
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $177.83
Regence BlueShield
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$199.53 / $199.53 / $199.53
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $302.00 / $354.81
Regence BlueShield
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$104.71 / $141.25 / $186.21
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.82 / $269.15 / $380.19
Select Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$74.13 / $120.23 / $173.78
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.15 / $158.49 / $288.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.82 / $177.83 / $295.12
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$75.86 / $79.43 / $131.83