Ultrasound pelvic complete
| 2020 CPT/HCPCS | 76856 |
| Negotiated Private Fee | $110.00 |
| Prossam | $70.00 |
| Champva | $113.03 |
| First Medical | $40.00 |
| First Medical Vital | Not Covered |
| Plan de Salud Menonita | $75.00 |
| Menonita Vital | $79.54 |
| Humana Gold plus/ Gold choice | Ambulatory Payment classification (APC) |
| Humana | $62.00 |
| Mapfre | $75.00 |
| Mcs Classicare | $75.00 |
| MCS Life | $75.00 |
| Medicare | Ambulatory Payment classification (APC) |
| MMM | $91.16 |
| MMM Vital | $79.54 |
| Panamerican Life | $90.00 |
| PMC | $91.16 |
| Tricare | $111.04 |
| Triple S Salud | $75.00 |
| Triple S Vital | $41.22 |
| Triple S Advantage | Ambulatory Payment classification (APC) |
| Negotiated Minimum Charge | $40.00 |
| Negotiated Maximus Charge | $113.03 |
| Discounted Cash Price | $88.00 |
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