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Washington 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
$45.71 / $60.26 / $151.36
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.50 / $186.21 / $602.56
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$36.31 / $72.44 / $239.88
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$56.23 / $89.13 / $354.81
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $177.83 / $229.09
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$30.20 / $67.61 / $89.13
Ambetter
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$74.13 / $89.13 / $162.18
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$9.77 / $45.71 / $66.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.71 / $181.97 / $346.74
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$41.69 / $67.61 / $120.23
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$66.07 / $117.49 / $218.78
Kaiser Permanente
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$47.86 / $79.43 / $288.40
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.23 / $213.80 / $302.00
Kaiser Permanente
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$44.67 / $77.62 / $104.71
Kaiser Permanente
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$75.86 / $138.04 / $199.53
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $64.57
Pacific Source
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$61.66 / $79.43 / $85.11
Pacific Source
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$50.12 / $74.13 / $91.20
Pacific Source
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$83.18 / $123.03 / $154.88
Premera BCBS
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$54.95 / $54.95 / $54.95
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.36 / $245.47 / $316.23
Premera BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$54.95 / $89.13 / $120.23
Premera BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$95.50 / $158.49 / $204.17
Regence BlueShield
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$213.80 / $213.80 / $213.80
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.36 / $218.78 / $302.00
Regence BlueShield
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$56.23 / $81.28 / $112.20
Regence BlueShield
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$95.50 / $138.04 / $190.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.65 / $123.03 / $275.42
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$41.69 / $44.67 / $104.71
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$69.18 / $79.43 / $177.83
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.82 / $131.83 / $218.78
Wellpoint
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$41.69 / $47.86 / $79.43
Wellpoint
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$74.13 / $85.11 / $141.25