Ultrasound order form
Send the request below with the exams you need and the clinical indication, and our scheduling team picks it up straight away.
A provider's order is required. The form below reaches our scheduling team and a person confirms the details with you. It is not where the signed order goes: send that through the RapidRAD portal, or download the ultrasound referral form (PDF) and fax it to (406) 206-5015. Please keep patient identifiers out of the form below. 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.
Request an ultrasound.
Tell us the study and the indication, and our scheduling team confirms the details with you, usually the same day. Fields marked * are required.
Other ways to order: the RapidRAD portal, the printable referral form by fax to (406) 206-5015, or by phone. See all four options.