How can I find out the cost of a specific medical procedure or service before I receive it?

Finding the exact cost of a medical procedure can be complex as prices vary based on your location, the specific provider, and your insurance coverage. To get an estimate for a medical service, you can use a fee schedule lookup tool. We recommend using Payerprice, which allows you to search for costs using a CPT code and your specific location. This can provide a clearer picture of potential expenses before your appointment.

What is a CPT code and why is it important for understanding medical costs?

CPT stands for Current Procedural Terminology. CPT codes are standardized five-digit codes used by healthcare providers to describe medical, surgical, and diagnostic services to payers for accurate billing and reimbursement. Understanding the CPT code for your specific procedure is crucial because it acts as a universal identifier for that service. Tools like Payerprice use CPT codes to provide specific fee schedule information, helping you look up and compare costs for exactly the service you need.

Why do prices for the same medical procedure vary significantly between different providers or locations?

Medical procedure prices can vary widely due to several factors including negotiated rates with different insurance companies, facility fees, geographic location, the provider's specialization and experience, and the overall cost of doing business in a particular area. Each healthcare provider or facility sets its own "chargemaster" price, which can then be adjusted by payer contracts. Tools like Payerprice help consumers navigate these variations by providing localized fee schedules, allowing you to compare potential costs for CPT codes in your specific area.

What information do I need to use a tool like Payerprice effectively to find medical costs?

To effectively use a fee schedule lookup tool like Payerprice and get the most accurate cost estimates for a medical service, you will primarily need two pieces of information: 1. **CPT Code:** This is the specific code that identifies the medical procedure or service you are interested in. You can often get this from your doctor's office. 2. **Specific Location:** The ZIP code or city and state where you plan to receive the service, as costs can vary significantly by region. With these details, Payerprice's fee schedule lookup tool can provide relevant pricing information.

CPT 76604 Fee Schedule

Q: Factors that affect fee schedules

Factors that affect fee schedules include: Medicare & Medicaid Rates (Government-set reimbursement amounts), Private Insurance Rates (Negotiated rates between providers and insurance companies), Geographic Location (Costs may be higher in urban areas.), and Provider Type (Hospital providers may have different rates than private practice.).

Last Verified: September 2026

Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.

Ultrasou Chst (Inclu Mediastinum) Real Time W/ Image Documen, Ultrasound Chest (Includes Mediastinum) Real Time With Image Documen

Key Fact	Detail
Service Type	Radiology Procedures Diagnostic Ultrasound Procedures
Common Place of Service	21 - Inpatient Hospital 23 - Emergency Room
Common Modifiers	None 26 - Professional component 52 - Reduced Services
Complexity Level	Low
Medicare Fee Schedule	View Medicare rates for 76604
Medicaid Fee Schedule	View Medicaid rates for 76604

National average reimbursement for CPT 76604 by major payers:

$75.91

$95.39

$93.76

$103.03

Compare published rates across providers.

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CPT 76604

5 of 25 sample ratesHigher to lower in this preview

Chu Chen
Merrimack Valley Pediatric Associates, Inc.
MAPediatrics PhysicianNPI 1073502985Tax ID 42-484572
$203.08Published rate
Oliver Archibald
St Peters Hospital
NYHospitalist PhysicianNPI 1174508105Tax ID 14-1348692
$108.02Published rate
Jason Heckman
St Peters Hospital
NYSurgery PhysicianNPI 1487755732Tax ID 14-1348692
$64.54Published rate
Christopher Raio
St Francis Hospital
NYEmergency Medicine PhysicianNPI 1255478004Tax ID 11-2050523
$39.69Published rate
Emanuel Corbo
Park Pediatrics PA
NJPediatrics PhysicianNPI 1013000413Tax ID 22-3119347
$24.81Published rate

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Summit Women's CareDenver, Colorado

September 2, 2026

Contracting Manager
UnitedHealthcare
Commercial PPO

Re: Request for fee schedule renegotiation

We request a formal review of our Commercial PPO fee schedule. The comparison below summarizes our current rate alongside published rates for comparable Denver-area practices.

Market evidence · CPT 59485

Current rate: $152.40
Market median: $147.00
Market position: 61st percentile

The comparison includes 1,284 published rates from 96 provider groups, scoped to OB/GYN providers in a professional, office-based setting.

We would welcome a discussion of our fee schedule and the supporting July 2026 market analysis. Please let us know a suitable time to review the comparison together.

Sincerely,
Summit Women's Care

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CPT 76604 vs. Other Diagnostic Ultrasound Procedures Codes

The CPT 76604 code is part of the Radiology Procedures services used for Diagnostic Ultrasound Procedures. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.

The CPT 76604 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.

Code	Complexity	Description
76604-CPT	Low	Ultrasou Chst (Inclu Mediastinum) Real Time W/ Image Documen, Ultrasound Chest (Includes Mediastinum) Real Time With Image Documen
76641-CPT	Low	Ultrasound Breast Complete, Ultrasound Breast Unilateral Real Time With Image Documentation Including Axilla When Performed Complete
76642-CPT	Low	Ultrasound Breast Limited, Ultrasound Breast Unilateral Real Time With Image Documentation Including Axilla When Performed Limited
76705-CPT	Low	Echography Abdominal B-Scan, Echography Abdominal B-Scan Andor Real Time With Imagedocumentation Limited (Eg Single Organ Quadrant Follow-Up)

What is a fee schedule?

A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 76604. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the 76604 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.

Factors that affect fee schedules

Medicare & Medicaid Rates

Government-set reimbursement amounts

Private Insurance Rates

Negotiated rates between providers and insurance companies

Geographic Location

Costs may be higher in urban areas.

Provider Type

Hospital providers may have different rates than private practice.

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CPT 76604 Fee Schedule

Chu Chen

Oliver Archibald

Jason Heckman

Christopher Raio

Emanuel Corbo