Ultrasound order form
Complete the order below, including the exams you need and the clinical indication, and our scheduling team picks it up straight away.
A provider's order is required. This form goes straight to our scheduling team. If you would rather work on paper, download the ultrasound referral form (PDF), fill it in and fax it to (406) 206-5015. Self-pay patients can see what the study costs before ordering.
The price, before you order.
Cash prices for 2026. Every one includes the radiologist's reading fee, so there is no second bill weeks later. Medicare and Medicaid are accepted as well, and what you owe on those depends on your plan.
| CPT | Exam | Cash price |
|---|---|---|
| 76700 | Abdomen, complete | $377.31 |
| 76705 | Abdomen, limited, single organ or quadrant | $303.88 |
| 76856 | Pelvic | $338.27 |
| 76536 | Neck, thyroid or parathyroid, and soft tissue | $357.80 |
| 76641 | Breast, complete, left or right | $331.77 |
| 93970 | Lower extremity veins, bilateral (suspected DVT) | $611.50 |
| 93880 | Carotid duplex, bilateral | $631.02 |
| 76801 | Obstetric, uterus, under 14 weeks | $377.31 |
Eight of the forty-three studies we price. See the full 2026 price list, or download it as a PDF. We confirm the exact price for your study when we schedule.
Other ways to order: the RapidRAD portal, the printable referral form by fax to (406) 206-5015, or by phone. See all four options.