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South Dakota 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
$30.90 / $30.90 / $30.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $147.91 / $263.03
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$30.20 / $66.07 / $102.33
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$47.86 / $91.20 / $446.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.88 / $194.98 / $239.88
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$57.54 / $72.44 / $91.20
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$95.50 / $120.23 / $151.36
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $151.36 / $524.81
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$33.11 / $64.57 / $194.98
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$52.48 / $104.71 / $331.13
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.49 / $190.55 / $190.55
Midlands
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$61.66 / $75.86 / $75.86
Midlands
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$97.72 / $112.20 / $112.20
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $131.83 / $154.88
Sanford Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$38.02 / $50.12 / $58.88
Sanford Health Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$60.26 / $83.18 / $97.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $128.82 / $186.21
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$32.36 / $50.12 / $70.79
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$53.70 / $79.43 / $123.03
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.54 / $169.82 / $169.82
Wellmark
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$54.95 / $64.57 / $64.57
Wellmark
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$89.13 / $104.71 / $104.71