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California rates for HCPCS 76857

Us Pelvic Nonobstetric Image Dcmtn Limited/F/U

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$18.02 / $22.01 / $143.57
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.10 / $98.16 / $340.90
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$16.92 / $31.23 / $98.32
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$25.02 / $64.31 / $139.03
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.53 / $46.74 / $108.55
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$17.63 / $23.34 / $52.90
Ambetter
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$30.73 / $30.73 / $41.18
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.47 / $97.50 / $180.30
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$19.29 / $25.95 / $55.67
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$32.70 / $71.42 / $124.06
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.53 / $100.00 / $228.08
Blue Shield
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$15.57 / $21.60 / $57.62
Blue Shield
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$59.96 / $79.44 / $176.40
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
$42.39 / $92.13 / $189.83
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$19.34 / $27.04 / $66.02
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$21.18 / $53.10 / $126.84
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.17 / $62.55 / $84.44
Contra Costa Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$21.09 / $26.15 / $35.29
Contra Costa Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$21.09 / $36.40 / $49.14
HealthNet
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.91 / $61.91 / $61.91
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.91 / $65.98 / $130.00
Kaiser Permanente
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$23.20 / $32.60 / $54.86
Kaiser Permanente
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$29.45 / $42.74 / $71.48
Lucent Health
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$55.69 / $115.00 / $115.19
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.66 / $592.92 / $592.92
Lucent Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$232.81 / $232.81 / $232.81
Lucent Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$385.57 / $398.91 / $409.84
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.99 / $32.34 / $32.34
Providence
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$26.65 / $26.65 / $26.65
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.26 / $94.52 / $148.58
Providence
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$19.34 / $26.20 / $62.74
Providence
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$21.18 / $56.31 / $124.84
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$160.51 / $160.51 / $160.51
Sutter Health Plus
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$80.53 / $80.53 / $80.53
Sutter Health Plus
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$79.98 / $79.98 / $79.98
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.58 / $69.54 / $102.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.34 / $68.72 / $154.93
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$14.94 / $25.26 / $63.04
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$23.64 / $38.86 / $93.00