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Michigan rates for HCPCS 76801

Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14 weeks 0 days), transabdominal approach; single or first gestation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$55.71 / $55.71 / $70.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.46 / $142.88 / $489.55
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$42.60 / $55.72 / $172.85
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$64.63 / $83.30 / $156.18
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.89 / $113.04 / $179.04
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$36.90 / $57.68 / $83.05
Ambetter
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$57.02 / $61.67 / $120.40
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.70 / $140.49 / $193.32
BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$63.38 / $74.56 / $74.56
BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$94.61 / $111.31 / $111.31
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.24 / $80.12 / $137.96
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$53.62 / $53.62 / $53.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.79 / $150.03 / $320.83
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$37.75 / $57.62 / $135.90
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$55.87 / $88.85 / $203.62
Health Alliance Plan
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$38.17 / $55.71 / $70.20
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$103.21 / $136.38 / $270.58
Health Alliance Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$38.17 / $55.71 / $104.47
Health Alliance Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$65.04 / $79.34 / $127.14
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.56 / $79.45 / $123.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.96 / $134.75 / $188.81
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$43.22 / $53.21 / $72.23
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$67.39 / $81.98 / $110.85