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Maryland rates for HCPCS 76857

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

Facilitymedian $25 · 10th–90th $20$290%20%10th90th$25Professionalmedian $49 · 10th–90th $21$1620%5%10th90th$49$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
$19.95 / $24.55 / $28.84
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$39.81 / $83.18 / $281.84
Aetna
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$19.95 / $37.15 / $81.28
Aetna
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$19.05 / $33.88 / $104.71
CareFirst
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$22.39 / $50.12 / $63.10
CareFirst
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$20.89 / $23.99 / $28.18
CareFirst
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$27.54 / $29.51 / $35.48
Cigna
Facility/Professional
Facility
Modifier
26
Typical Low / Median / Typical High
$38.02 / $38.02 / $38.02
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$38.90 / $70.79 / $134.90
Cigna
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$16.22 / $23.44 / $43.65
Cigna
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$21.38 / $38.90 / $97.72
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$53.70 / $63.10 / $97.72
Kaiser Permanente
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$21.88 / $28.18 / $38.90
Kaiser Permanente
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$29.51 / $34.67 / $51.29
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$42.66 / $72.44 / $138.04
United
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$15.85 / $23.99 / $58.88
United
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$21.38 / $40.74 / $102.33
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$47.86 / $66.07 / $77.62
Wellpoint
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$21.88 / $29.51 / $35.48
Wellpoint
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$25.70 / $37.15 / $42.66