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See a sample rate comparisonCPT 76642 Fee Schedule
Medicare rates as of October 2026
CPT 76642 is classified under Radiology Procedures, in the Diagnostic Ultrasound Procedures subgroup.
Ultrasound Breast Limited, Ultrasound Breast Unilateral Real Time With Image Documentation Including Axilla When Performed Limited
| Key Fact | Detail |
|---|---|
| Service Type | Radiology Procedures Diagnostic Ultrasound Procedures |
| Common Place of Service | 22 - On Campus Outpatient Hospital 11 - Office |
| Common Modifiers | LT - Left side of body 26 - Professional component |
| Complexity Level | Low |
| Medicare Fee Schedule | $83.50 national non-facility rate (2026) · View Medicare rates for 76642 |
| Medicaid Fee Schedule | $67.40 median of the 8 states in the free preview · View Medicaid rates for 76642 |
National average reimbursement for CPT 76642 by major payers:
$116.46
BCBS / Anthem
$104.69
UnitedHealthcare
$109.59
Aetna
$134.42
Cigna
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CPT 76642
5 of 25 sample ratesHigher to lower in this preview
Rahul Sawlani
$351.80Published rateJohn Matson
University Of Virginia Physicians Group
$127.13Published rateRochelle Nagales Nagamos
Summit Medical Group, P.A.
$88.98Published rateSamuel Apata
Goodwill Diagnostic Services LLC
$54.49Published rateRonald Walsh
St Josephs Hospital Yonkers
$17.89Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 76642 vs. Other Diagnostic Ultrasound Procedures Codes
The table lists codes related to 76642. Select one to see its fee schedule.
| Code | Complexity | Description |
|---|---|---|
| 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 |
| 76700-CPT | Low | Ultrasound Abdominal |
| 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 76642. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 76642 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
CPT stands for Current Procedural Terminology. CPT codes are five-digit numerical codes used by healthcare providers, payers, and government agencies to describe medical, surgical, and diagnostic services. They are essential for accurate billing and record-keeping in healthcare.
To find the cost of a specific medical procedure or service, it's best to look up the fee schedule associated with its CPT code in your specific location. For reliable and detailed information, you can use tools like Payerprice, which offers a fee schedule lookup tool where you can search by CPT code and specific location to get pricing information. You can also contact your insurance provider directly for an estimate of your out-of-pocket costs based on your plan.
A healthcare provider's charge is the full amount they bill for a service, often called the "list price." What you actually pay, or your "out-of-pocket" cost, is usually much lower. This is because insurance companies negotiate discounted rates with providers (the "allowed amount"), and your payment depends on your specific insurance plan's deductible, co-insurance, and co-payment. Tools like Payerprice can help you understand these negotiated rates and fee schedules.
Healthcare costs can vary significantly due to several factors, including the specific provider or facility, geographic location, insurance company negotiations, the type of insurance plan, and whether the service is in-network or out-of-network. Different providers have different overheads and pricing strategies, and negotiated rates with various insurers also differ widely. Resources like Payerprice can help you compare costs for CPT codes across different locations and payers.
To find specific fee schedules for CPT codes in your area, you can utilize specialized lookup tools. Payerprice offers a fee schedule lookup tool that allows you to search with a CPT code and your specific location to find relevant pricing information. This can provide a more granular view than general price transparency tools. You may also be able to obtain some information directly from your insurance provider or by checking the price transparency tools provided by hospitals or healthcare systems, though these can be harder to navigate for specific CPT codes.