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Indiana rates for HCPCS 76857

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

Facilitymedian $28 · 10th–90th $22$390%20%10th90th$28Professionalmedian $46 · 10th–90th $21$1120%5%10th90th$46$5.0$10.0$20.0$50.0$100.0$200.0$500.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Typical Low / Median / Typical High
$21.88 / $28.18 / $38.90
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$40.74 / $79.43 / $181.97
Aetna
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$19.95 / $33.88 / $66.07
Aetna
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$19.95 / $28.18 / $72.44
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$38.02 / $48.98 / $74.13
Ambetter
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$18.20 / $22.91 / $38.02
Ambetter
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$23.44 / $32.36 / $50.12
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$48.98 / $67.61 / $109.65
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$17.78 / $19.50 / $33.11
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$30.90 / $48.98 / $77.62
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$22.91 / $29.51 / $58.88
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$44.67 / $85.11 / $165.96
Cigna
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$18.20 / $26.30 / $45.71
Cigna
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$21.88 / $48.98 / $123.03
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$42.66 / $70.79 / $123.03
United
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$19.05 / $25.12 / $52.48
United
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$20.89 / $33.11 / $93.33