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Iowa 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
$20.89 / $41.69 / $50.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.74 / $91.20 / $338.84
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$19.05 / $38.90 / $107.15
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$19.05 / $44.67 / $107.15
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$58.88 / $60.26 / $61.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.61 / $120.23 / $158.49
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$21.38 / $54.95 / $69.18
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$37.15 / $64.57 / $89.13
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.77 / $141.25 / $275.42
Hally Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$22.39 / $39.81 / $89.13
Hally Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$23.99 / $112.20 / $204.17
Medica
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$60.26 / $114.82 / $114.82
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.98 / $95.50 / $575.44
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$19.50 / $31.62 / $234.42
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$22.91 / $54.95 / $398.11
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.72 / $120.23 / $181.97
Midlands
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$44.67 / $57.54 / $72.44
Midlands
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$50.12 / $61.66 / $138.04
Midlands
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$61.66 / $61.66 / $61.66
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.49 / $128.82 / $181.97
Midlands
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$37.15 / $57.54 / $63.10
Midlands
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$61.66 / $64.57 / $138.04
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.55 / $45.71 / $89.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.86 / $70.79 / $114.82
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$19.50 / $28.18 / $53.70
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$22.91 / $34.67 / $79.43
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.13 / $89.13 / $104.71
Wellmark
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$41.69 / $41.69 / $48.98
Wellmark
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$47.86 / $47.86 / $56.23