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Virginia 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
$20.91 / $31.59 / $56.63
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.06 / $53.26 / $110.77
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$18.78 / $22.60 / $45.64
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$21.07 / $25.02 / $65.34
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.48 / $57.74 / $83.82
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$20.23 / $25.89 / $37.19
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$23.97 / $31.05 / $51.33
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.17 / $57.33 / $290.83
CareFirst
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$25.00 / $27.78 / $52.50
CareFirst
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$29.54 / $29.54 / $57.60
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
$39.90 / $74.01 / $129.77
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$17.05 / $25.80 / $54.69
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$20.70 / $41.00 / $93.50
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.29 / $58.41 / $70.76
Kaiser Permanente
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$21.07 / $26.77 / $33.18
Kaiser Permanente
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$25.39 / $32.38 / $38.54
Medcost
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$27.90 / $32.00 / $65.98
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.00 / $60.00 / $137.79
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.14 / $79.59 / $141.09
Sentara
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$22.29 / $31.45 / $52.15
Sentara
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$26.32 / $46.45 / $93.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.25 / $66.23 / $116.23
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$15.08 / $25.26 / $39.76
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$19.14 / $36.18 / $93.25