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Texas 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
$14.95 / $19.37 / $30.39
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.13 / $73.73 / $278.97
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$16.04 / $20.07 / $71.16
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$16.30 / $25.67 / $77.25
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.71 / $45.34 / $60.75
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$17.63 / $22.78 / $43.45
Ambetter
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$13.69 / $19.55 / $32.42
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.10 / $37.28 / $49.48
Baylor Scott & White
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.92 / $61.00 / $97.00
Christus
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$22.05 / $23.52 / $35.61
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
$38.84 / $68.89 / $150.47
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$16.55 / $23.22 / $42.73
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$19.20 / $34.42 / $112.51
Lucent Health
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$55.69 / $115.19 / $115.19
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.66 / $592.92 / $592.92
Lucent Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$232.81 / $232.81 / $232.81
Lucent Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$385.57 / $398.91 / $409.84
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.01 / $67.73 / $149.44
Moda Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$26.56 / $33.96 / $90.56
Moda Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$30.36 / $38.82 / $103.52
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.53 / $34.40 / $81.78
Providence
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$26.65 / $26.65 / $26.65
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.72 / $73.12 / $146.01
Providence
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$16.23 / $22.74 / $39.81
Providence
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$18.79 / $30.50 / $118.34
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.83 / $57.17 / $108.70
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$18.95 / $24.31 / $38.34
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$19.48 / $29.14 / $87.13
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.41 / $46.73 / $65.88
Wellpoint
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$19.32 / $22.28 / $31.19
Wellpoint
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$22.09 / $24.45 / $35.13