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Maine rates for HCPCS 76816

Ultrasound, pregnant uterus, real time with image documentation, follow-up (eg, re-evaluation of fetal size by measuring standard growth parameters and amniotic fluid volume, re-evaluation of organ system(s) suspected or confirmed to be abnormal on a previous scan), transabdominal approach, per fetus

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$48.11 / $144.91 / $144.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.43 / $128.58 / $191.09
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$36.61 / $42.69 / $65.28
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$56.82 / $70.76 / $118.51
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$116.12 / $150.28 / $209.83
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$42.70 / $55.26 / $76.31
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$73.42 / $95.01 / $133.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.82 / $158.88 / $245.76
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$40.54 / $58.64 / $89.95
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$59.71 / $100.25 / $155.81
Community Health Options
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.66 / $175.57 / $220.29
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$113.87 / $155.00 / $237.78
Harvard Pilgrim
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$49.46 / $59.26 / $87.79
Harvard Pilgrim
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$84.50 / $101.24 / $165.66
Martin's Point
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$46.46 / $48.95 / $179.71
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$103.15 / $128.58 / $194.44
Martin's Point
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$38.81 / $48.11 / $71.55
Martin's Point
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$64.31 / $80.45 / $128.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.17 / $158.31 / $225.36
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$41.90 / $62.19 / $81.30
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$65.27 / $96.12 / $144.06