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Payers and negotiated rates for CPT 76642-LT | medprice.ai

CPT 76642-LT

""US BREAST LIMITED LEFT""

Payer pricing summary

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Low

$31

Average

$102

Median

$94

High

$276

Payer rate distribution

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Filter by billing methodology

All methodologies Case rate 0 Fee schedule 7 Per diem 0 Percent of billed charges 8 Other 0

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#
1	Aetna fee schedule · both · +2 other terms	1	$31	$31	—	—	—	$31 – $31
2	Amerihealth Caritas facility · percent of total billed charges · outpatientfrom % of charges	1	$98	$98	$1	1%	—	$97 – $99
3	Blue Cross Blue Shield percent of total billed charges · inpatientfrom % of charges · +1 other terms	1	$109	$109	—	—	—	$109 – $109
4	Cigna fee schedule · both · +3 other terms	1	$31	$31	—	—	—	$31 – $31
5	Highmark facility · percent of total billed charges · outpatientfrom % of charges	1	$199	$199	$62	31%	—	$96 – $262
6	Humana fee schedule · both · +3 other terms	1	$31	$31	—	—	—	$31 – $31
7	MultiPlan facility · percent of total billed charges · inpatientfrom % of charges · +1 other terms	1	$276	$276	—	—	—	$276 – $276
8	Optum fee schedule · both	1	$31	$31	—	—	—	$31 – $31
9	Tricare fee schedule · both	1	$31	$31	—	—	—	$31 – $31
10	UnitedHealthcare fee schedule · both · +3 other terms	1	$31	$31	—	—	—	$31 – $31

Page 1 of 2 · 11 payers

← Hospitals reporting CPT 76642-LT · Snapshot 20261113T090226Z-3ce6c0b8