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Arizona rates for HCPCS 76857

Ultrasound, pelvic (nonobstetric), real time with image documentation; limited or follow-up (eg, for follicles)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$26.86 / $45.47 / $86.77
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.88 / $84.79 / $321.32
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$16.92 / $28.08 / $95.56
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$25.02 / $56.82 / $118.52
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.20 / $41.85 / $64.72
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$17.92 / $24.65 / $43.45
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.92 / $42.56 / $53.20
BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$13.96 / $18.61 / $23.26
BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$17.96 / $23.95 / $29.94
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$26.65 / $26.65 / $26.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.94 / $79.09 / $136.30
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$18.11 / $25.35 / $45.62
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$21.05 / $39.77 / $100.78
Medica
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$115.00 / $115.00 / $115.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.52 / $98.82 / $575.66
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$19.77 / $25.26 / $232.81
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$23.69 / $63.11 / $398.91
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.52 / $59.33 / $110.36
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$19.05 / $25.26 / $37.10
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$22.92 / $32.35 / $87.13