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Louisiana 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
$24.60 / $30.32 / $39.43
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.88 / $57.10 / $95.04
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$16.92 / $27.48 / $36.36
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$20.50 / $26.52 / $64.31
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.27 / $47.70 / $73.87
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$21.94 / $24.61 / $43.45
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.19 / $66.37 / $96.99
BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$23.15 / $30.24 / $40.85
BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$26.62 / $32.84 / $70.66
Christus
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$21.39 / $23.53 / $35.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.77 / $50.53 / $112.38
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$14.59 / $23.53 / $43.15
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$15.18 / $24.66 / $88.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.08 / $54.38 / $108.76
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$16.67 / $24.91 / $37.36
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$18.62 / $25.67 / $66.95