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New York 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
$18.85 / $25.44 / $62.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.84 / $82.29 / $311.95
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$4.71 / $24.08 / $77.34
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$17.98 / $46.09 / $82.94
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.52 / $39.36 / $90.14
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$16.64 / $18.50 / $39.52
Ambetter
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$30.73 / $30.73 / $30.73
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.01 / $52.31 / $155.11
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$18.55 / $23.53 / $47.74
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$21.45 / $27.21 / $98.04
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.79 / $33.86 / $67.66
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$26.65 / $26.65 / $26.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.39 / $95.63 / $252.14
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$17.20 / $30.57 / $67.93
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$20.72 / $52.36 / $133.57
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.85 / $68.73 / $126.42
Emblem Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$22.91 / $30.29 / $48.77
Emblem Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$28.15 / $36.56 / $65.06
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.40 / $67.00 / $104.49
Excellus BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$10.74 / $31.04 / $49.62
Excellus BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$24.24 / $40.06 / $57.54
Fidelis
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.88 / $53.89 / $76.61
Fidelis
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$19.30 / $22.36 / $22.36
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.92 / $64.30 / $95.75
Highmark BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$26.70 / $28.48 / $49.68
MVP Health Care
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$26.65 / $26.65 / $26.65
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.77 / $81.58 / $204.30
MVP Health Care
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$18.41 / $31.31 / $67.43
MVP Health Care
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$23.27 / $35.75 / $125.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.38 / $57.16 / $121.02
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$16.85 / $24.44 / $55.20
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$19.66 / $27.31 / $73.56
Univera
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$27.23 / $27.23 / $60.86
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.75 / $67.00 / $129.63
Univera
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$10.74 / $31.46 / $61.52
Univera
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$26.13 / $38.90 / $66.44