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See a sample rate comparisonCPT 76604 Fee Schedule
Medicare rates as of October 2026
CPT 76604 is classified under Radiology Procedures, in the Diagnostic Ultrasound Procedures subgroup.
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 | 26 - Professional component 52 - Reduced Services |
| Complexity Level | Low |
| Medicare Fee Schedule | $61.12 national non-facility rate (2026) · View Medicare rates for 76604 |
| Medicaid Fee Schedule | $49.295 median of the 8 states in the free preview · View Medicaid rates for 76604 |
National average reimbursement for CPT 76604 by major payers:
$75.91
BCBS / Anthem
$95.39
UnitedHealthcare
$93.76
Aetna
$103.03
Cigna
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CPT 76604
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$203.08Published rateOliver Archibald
St Peters Hospital
$108.02Published rateJason Heckman
St Peters Hospital
$64.54Published rateChristopher Raio
St Francis Hospital
$39.69Published rateEmanuel Corbo
Park Pediatrics PA
$24.81Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 76604 vs. Other Diagnostic Ultrasound Procedures Codes
The table lists codes related to 76604. Select one to see its fee schedule.
| 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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Frequently Asked Questions
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.
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.
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.
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.