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Pennsylvania rates for HCPCS 76812

Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal anatomic examination, transabdominal approach; each additional gestation (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$83.12 / $109.25 / $244.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$133.50 / $194.04 / $404.65
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.80 / $277.97 / $277.97
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$184.67 / $247.73 / $373.28
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$96.73 / $96.73 / $96.73
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.49 / $233.36 / $370.77
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$202.83 / $260.58 / $557.73
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$211.14 / $232.26 / $354.38
Martin's Point
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$83.12 / $126.34 / $265.98
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$145.56 / $247.04 / $454.05
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.64 / $163.40 / $356.63
Priority Health
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$96.73 / $96.73 / $96.73
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.49 / $232.96 / $369.12
UPMC Health Plan
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$83.36 / $83.36 / $87.55
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$183.32 / $185.78 / $199.14
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$150.05 / $202.46 / $357.60