Cost analysis for CPT 76642 — Limited ultrasound scan of 1 breast
Average Medicare Payment
$35.89
2023 data
Total Payments (2023)
$24.3M
Services (2023)
643.6K
Price Change (2015–2023)
-3.8%
| Year | Avg Payment | Total Payments | Services | YoY Change |
|---|---|---|---|---|
| 2015 | $37.31 | $26.4M | 685.6K | — |
| 2016 | $35.91 | $25.7M | 691.3K | -3.8% |
| 2017 | $35.52 | $25.6M | 697.9K | -1.1% |
| 2018 | $35.84 | $26.1M | 709.4K | +0.9% |
| 2019 | $36.39 | $27.2M | 725.9K | +1.5% |
| 2020 | $36.42 | $24.1M | 633.0K | +0.1% |
| 2021 | $36.87 | $26.5M | 688.8K | +1.2% |
| 2022 | $35.52 | $24.6M | 661.0K | -3.7% |
| 2023 | $35.89 | $24.3M | 643.6K | +1.0% |
The most expensive state pays 2.5x more than the cheapest for this procedure. MD averages $58.86 vs WV at $23.20.
| State | Avg Payment | Total Payments | Services | Providers |
|---|---|---|---|---|
| MD | $58.86 | $1.2M | 20.1K | 179 |
| NJ | $53.87 | $1.3M | 23.6K | 296 |
| DC | $49.45 | $222.4K | 4.5K | 44 |
| AZ | $49.44 | $597.4K | 12.1K | 136 |
| NV | $48.96 | $163.5K | 3.3K | 61 |
| CA | $48.35 | $3.0M | 61.2K | 750 |
| FL | $47.09 | $2.0M | 43.0K | 526 |
| NY | $46.34 | $1.7M | 35.6K | 556 |
| AP | $44.64 | $4.6K | 103 | 2 |
| CO | $42.57 | $482.3K | 11.3K | 134 |
| AK | $42.15 | $79.4K | 1.9K | 25 |
| RI | $41.57 | $148.3K | 3.6K | 37 |
| CT | $41.46 | $343.2K | 8.3K | 154 |
| WA | $40.07 | $637.5K | 15.9K | 173 |
| NM | $38.92 | $132.6K | 3.4K | 46 |
| WY | $38.68 | $36.4K | 941 | 21 |
| DE | $38.38 | $127.2K | 3.3K | 34 |
| AR | $37.46 | $262.1K | 7.0K | 92 |
| NC | $37.43 | $900.1K | 24.0K | 361 |
| MN | $37.23 | $441.8K | 11.9K | 203 |
| VA | $37.18 | $799.1K | 21.5K | 270 |
| HI | $36.71 | $74.4K | 2.0K | 35 |
| TX | $36.31 | $1.0M | 28.4K | 466 |
| GA | $34.87 | $661.2K | 19.0K | 290 |
| IA | $34.52 | $263.6K | 7.6K | 123 |
| TN | $34.10 | $569.0K | 16.7K | 265 |
| KS | $33.34 | $234.9K | 7.0K | 102 |
| AL | $31.96 | $223.1K | 7.0K | 146 |
| IL | $31.82 | $1.0M | 32.8K | 409 |
| MA | $30.79 | $694.5K | 22.6K | 311 |
| NH | $29.93 | $87.9K | 2.9K | 61 |
| OR | $29.69 | $238.8K | 8.0K | 111 |
| NE | $29.51 | $152.2K | 5.2K | 86 |
| MT | $29.21 | $58.2K | 2.0K | 34 |
| WI | $29.18 | $285.1K | 9.8K | 237 |
| SC | $29.05 | $323.2K | 11.1K | 129 |
| PA | $28.75 | $925.5K | 32.2K | 414 |
| LA | $28.00 | $203.5K | 7.3K | 148 |
| MO | $27.51 | $436.2K | 15.9K | 225 |
| MS | $27.31 | $146.3K | 5.4K | 84 |
| IN | $27.28 | $317.1K | 11.6K | 169 |
| SD | $27.16 | $64.3K | 2.4K | 40 |
| MI | $27.15 | $467.5K | 17.2K | 262 |
| KY | $26.74 | $207.6K | 7.8K | 117 |
| OK | $26.65 | $231.2K | 8.7K | 100 |
| OH | $25.88 | $566.2K | 21.9K | 327 |
| UT | $25.58 | $74.5K | 2.9K | 58 |
| ND | $25.35 | $64.6K | 2.5K | 36 |
| ME | $24.67 | $67.8K | 2.8K | 64 |
| VT | $24.56 | $34.7K | 1.4K | 26 |
| ID | $23.46 | $62.3K | 2.7K | 48 |
| Provider | Specialty | State | Payments | Services | Avg/Service |
|---|---|---|---|---|---|
| Ronald Mattison | General Surgery | TN | $52.6K | 797 | $66.03 |
| Mary Goodwin | General Surgery | GA | $42.3K | 635 | $66.60 |
| Sergio Dromi | Diagnostic Radiology | FL | $37.7K | 586 | $64.29 |
| Joan Berkowitz | Diagnostic Radiology | MD | $37.6K | 519 | $72.39 |
| Reema Munir | Diagnostic Radiology | CA | $37.3K | 486 | $76.85 |
| Jon Foran | Diagnostic Radiology | CA | $36.9K | 470 | $78.43 |
| Saint Barnabas Outpatient Centers | Independent Diagnostic Testing Facility (IDTF) | NJ | $35.8K | 713 | $50.28 |
| Daniel Aronson | Diagnostic Radiology | MD | $35.7K | 490 | $72.92 |
| Geraldine Chang | Diagnostic Radiology | CA | $35.2K | 581 | $60.53 |
| Pia Luedtke | Diagnostic Radiology | CA | $33.2K | 386 | $86.05 |
| Omid Bendavid | Diagnostic Radiology | CA | $31.1K | 397 | $78.33 |
| Arpita Swami | Diagnostic Radiology | WA | $28.2K | 458 | $61.62 |
| Naomi Kraut | Diagnostic Radiology | MD | $27.9K | 391 | $71.23 |
| Thu Nguyen | Diagnostic Radiology | MD | $27.3K | 382 | $71.57 |
| Ewa Bauer | Diagnostic Radiology | CA | $27.2K | 410 | $66.31 |
| Steven Nokes | Diagnostic Radiology | TN | $26.5K | 414 | $63.93 |
| Cristina Campassi | Diagnostic Radiology | MD | $26.3K | 360 | $73.04 |
| Khiet Nguyen | Diagnostic Radiology | MD | $25.9K | 326 | $79.39 |
| Jocelyn Scheinert | Diagnostic Radiology | MD | $25.4K | 326 | $77.79 |
| Jason Mckellop | Diagnostic Radiology | NY | $25.2K | 314 | $80.23 |
The data suggests significant pricing inconsistencies for CPT 76642. With a 2.5x price gap between the most and least expensive states, geography plays an outsized role in what Medicare pays for this procedure.
Costs have remained relatively stable over time, but the geographic variation suggests Medicare's geographic adjustment factors may not fully capture the true cost differences across states.
This analysis is based on publicly available CMS data and does not account for patient complexity, comorbidities, or facility-specific factors that may justify pricing differences.
Note: All data is from publicly available Medicare records. OpenMedicare is an independent journalism project not affiliated with CMS.