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California rates for HCPCS 76817

Ultrasound, pregnant uterus, real time with image documentation, transvaginal

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$34.04 / $41.95 / $217.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.95 / $169.76 / $512.00
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$32.13 / $59.01 / $189.00
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$54.47 / $69.69 / $245.50
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.38 / $117.15 / $250.93
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$26.32 / $38.50 / $80.50
Ambetter
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$87.25 / $87.25 / $87.25
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$103.74 / $135.47 / $270.52
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$39.43 / $51.69 / $101.46
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$64.05 / $85.04 / $171.13
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.28 / $105.86 / $255.15
Blue Shield
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$33.49 / $42.05 / $100.00
Blue Shield
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$50.79 / $67.69 / $158.93
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$40.86 / $40.86 / $40.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.29 / $128.72 / $279.56
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$32.74 / $47.18 / $104.59
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$55.05 / $82.57 / $182.87
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.17 / $116.93 / $157.86
Contra Costa Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$30.40 / $39.68 / $53.57
Contra Costa Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$51.77 / $77.26 / $104.30
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.00 / $118.53 / $224.11
Kaiser Permanente
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$35.04 / $49.44 / $83.19
Kaiser Permanente
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$61.81 / $90.63 / $151.52
Lucent Health
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$84.15 / $163.00 / $174.61
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$600.27 / $600.27 / $764.25
Lucent Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$233.19 / $240.89 / $285.00
Lucent Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$372.64 / $372.64 / $479.25
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $32.34 / $67.43
Providence
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$40.86 / $40.86 / $40.86
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.70 / $141.02 / $276.08
Providence
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$32.81 / $45.47 / $101.80
Providence
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$55.05 / $80.84 / $179.61
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$318.58 / $318.58 / $318.58
Sutter Health Plus
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$121.99 / $121.99 / $121.99
Sutter Health Plus
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$196.59 / $196.59 / $196.59
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.57 / $115.04 / $139.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.03 / $98.82 / $274.54
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$26.46 / $38.25 / $106.57
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$47.01 / $60.68 / $182.76