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Missouri rates for HCPCS 76815

Ultrasound, pregnant uterus, real time with image documentation, limited (eg, fetal heart beat, placental location, fetal position and/or qualitative amniotic fluid volume), 1 or more fetuses

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$27.92 / $36.94 / $57.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.64 / $125.71 / $472.95
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$27.64 / $49.03 / $143.00
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$43.68 / $61.17 / $172.97
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.80 / $81.61 / $112.99
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$22.91 / $35.79 / $52.23
Ambetter
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$69.06 / $79.70 / $79.70
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.47 / $95.35 / $159.33
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$32.32 / $39.76 / $62.56
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$45.14 / $56.51 / $100.38
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$35.11 / $35.11 / $35.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.08 / $105.12 / $178.02
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$26.38 / $41.07 / $75.81
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$40.95 / $64.77 / $110.31
Medica
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$72.90 / $139.28 / $139.28
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.39 / $104.39 / $524.64
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$30.95 / $40.38 / $195.35
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$50.66 / $63.38 / $329.23
Qualchoice
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$56.11 / $56.11 / $60.06
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.34 / $93.23 / $169.62
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$29.38 / $36.03 / $60.00
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$48.12 / $59.58 / $104.66