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Michigan rates for HCPCS 76857

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

Facilitymedian $28 · 10th–90th $28$300%50%90th$28Professionalmedian $56 · 10th–90th $22$2040%5%10th90th$56$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
$28.18 / $28.18 / $30.20
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$43.65 / $91.20 / $346.74
Aetna
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$19.05 / $38.02 / $97.72
Aetna
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$19.95 / $36.31 / $102.33
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$33.88 / $39.81 / $48.98
Ambetter
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$19.05 / $23.99 / $42.66
Ambetter
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$17.78 / $17.78 / $25.12
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$47.86 / $74.13 / $79.43
BCBS
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$37.15 / $37.15 / $50.12
BCBS
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$42.66 / $42.66 / $42.66
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$23.44 / $33.11 / $63.10
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$40.74 / $77.62 / $169.82
Cigna
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$17.38 / $27.54 / $60.26
Cigna
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$20.89 / $38.90 / $97.72
Health Alliance Plan
Facility/Professional
Facility
Modifier
26
Typical Low / Median / Typical High
$24.55 / $28.18 / $40.74
Health Alliance Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$46.77 / $79.43 / $223.87
Health Alliance Plan
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$18.20 / $30.20 / $69.18
Health Alliance Plan
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$22.91 / $40.74 / $93.33
Priority Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$39.81 / $67.61 / $141.25
Priority Health
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$17.38 / $25.70 / $41.69
Priority Health
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$19.95 / $29.51 / $83.18
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$47.86 / $83.18 / $151.36
United
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$19.95 / $28.18 / $114.82
United
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$22.91 / $38.02 / $100.00