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Wisconsin rates for HCPCS 76857

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

Facilitymedian $49 · 10th–90th $35$1150%10%20%10th90th$49Professionalmedian $66 · 10th–90th $22$2450%5%10th90th$66$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
$26.30 / $40.74 / $50.12
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$41.69 / $102.33 / $478.63
Aetna
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$19.95 / $39.81 / $147.91
Aetna
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$19.95 / $33.88 / $81.28
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$46.77 / $72.44 / $263.03
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$22.91 / $35.48 / $120.23
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$23.99 / $38.02 / $128.82
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$25.70 / $37.15 / $74.13
Cigna
Facility/Professional
Facility
Modifier
26
Typical Low / Median / Typical High
$61.66 / $70.79 / $114.82
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$67.61 / $151.36 / $199.53
Cigna
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$23.44 / $67.61 / $95.50
Cigna
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$36.31 / $87.10 / $107.15
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$91.20 / $104.71 / $141.25
DeanCare
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$42.66 / $48.98 / $66.07
DeanCare
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$47.86 / $54.95 / $74.13
Medica
Facility/Professional
Facility
Modifier
26
Typical Low / Median / Typical High
$114.82 / $114.82 / $114.82
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$52.48 / $117.49 / $575.44
Medica
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$21.88 / $48.98 / $234.42
Medica
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$25.12 / $72.44 / $398.11
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $109.65
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$66.07 / $128.82 / $239.88
Network Health
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$29.51 / $35.48 / $85.11
Network Health
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$33.11 / $66.07 / $194.98
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$66.07 / $123.03 / $213.80
Quartz
Facility/Professional
Facility
Modifier
26
Typical Low / Median / Typical High
$100.00 / $147.91 / $147.91
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$72.44 / $275.42 / $588.84
Quartz
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$25.70 / $123.03 / $234.42
Quartz
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$38.02 / $208.93 / $407.38
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$123.03 / $123.03 / $123.03
Security Health
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$61.66 / $61.66 / $61.66
Security Health
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$63.10 / $63.10 / $63.10
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $177.83 / $371.54
Security Health
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$63.10 / $72.44 / $109.65
Security Health
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$66.07 / $85.11 / $141.25
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$81.28 / $141.25 / $363.08
United
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$43.65 / $95.50 / $177.83
United
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$30.20 / $85.11 / $177.83