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Virginia 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
$67.61 / $131.83 / $467.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.82 / $165.96 / $316.23
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$57.54 / $72.44 / $162.18
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.96 / $234.42 / $338.84
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$72.44 / $100.00 / $144.54
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.44 / $173.78 / $489.78
CareFirst
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$74.13 / $81.28 / $123.03
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$18.62 / $87.10 / $123.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.04 / $208.93 / $371.54
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$61.66 / $91.20 / $162.18
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.18 / $204.17 / $257.04
Kaiser Permanente
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$66.07 / $83.18 / $104.71
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.80 / $269.15 / $288.40
Medcost
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$109.65 / $138.04 / $141.25
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.20 / $112.20 / $281.84
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.20 / $181.97 / $380.19
Sentara
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$77.62 / $102.33 / $158.49
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.83 / $177.83 / $302.00
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$57.54 / $79.43 / $134.90