go back

Montana 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
$43.24 / $43.24 / $43.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.36 / $82.48 / $340.90
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$16.92 / $27.02 / $98.00
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$46.09 / $64.31 / $100.45
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.28 / $36.28 / $77.81
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$36.28 / $36.28 / $44.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.59 / $77.81 / $115.03
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$19.26 / $36.28 / $52.01
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$29.85 / $41.54 / $75.94
Providence
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$36.28 / $36.28 / $44.85
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.82 / $80.90 / $127.59
Providence
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$25.18 / $36.28 / $41.77
Providence
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$29.85 / $41.54 / $69.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.34 / $59.33 / $99.90
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$20.28 / $25.26 / $42.70
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$24.18 / $34.17 / $78.54