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Montana rates for HCPCS 76857

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

Facilitymedian $44 · 10th–90th $36$450%50%10th90th$44Professionalmedian $52 · 10th–90th $23$1510%5%10th90th$52$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. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Typical Low / Median / Typical High
$43.65 / $43.65 / $43.65
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$45.71 / $85.11 / $281.84
Aetna
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$19.05 / $39.81 / $87.10
Aetna
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$19.95 / $46.77 / $72.44
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$36.31 / $77.62 / $77.62
Cigna
Facility/Professional
Facility
Modifier
26
Typical Low / Median / Typical High
$36.31 / $36.31 / $44.67
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $85.11 / $128.82
Cigna
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$18.62 / $36.31 / $54.95
Cigna
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$28.18 / $46.77 / $95.50
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$81.28 / $85.11 / $169.82
Providence
Facility/Professional
Facility
Modifier
26
Typical Low / Median / Typical High
$36.31 / $36.31 / $44.67
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$64.57 / $87.10 / $128.82
Providence
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$23.44 / $36.31 / $45.71
Providence
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$28.18 / $41.69 / $69.18
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$48.98 / $75.86 / $117.49
United
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$19.95 / $25.70 / $79.43
United
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$23.99 / $35.48 / $85.11