go back

Utah rates for HCPCS 76857

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

Facilitymedian $138 · 10th–90th $21$1380%50%10th$138Professionalmedian $54 · 10th–90th $21$1700%5%10th90th$54$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
$20.89 / $138.04 / $138.04
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$43.65 / $85.11 / $323.59
Aetna
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$19.95 / $32.36 / $79.43
Aetna
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$19.95 / $43.65 / $102.33
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $77.62 / $138.04
Cigna
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$20.89 / $31.62 / $48.98
Cigna
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$25.12 / $39.81 / $107.15
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.90 / $33.11 / $51.29
Regence BlueShield
Facility/Professional
Facility
Modifier
26
Typical Low / Median / Typical High
$199.53 / $199.53 / $199.53
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$69.18 / $85.11 / $102.33
Regence BlueShield
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$32.36 / $38.90 / $48.98
Regence BlueShield
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$37.15 / $45.71 / $61.66
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$48.98 / $77.62 / $104.71
Select Health
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$23.44 / $37.15 / $54.95
Select Health
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$25.70 / $40.74 / $48.98
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$25.70 / $41.69 / $83.18
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$47.86 / $54.95 / $117.49
United
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$19.95 / $25.12 / $41.69
United
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$22.91 / $26.30 / $95.50