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Utah rates for HCPCS 71275

Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if performed, and image postprocessing

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$107.15 / $549.54 / $549.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.04 / $389.05 / $1,659.59
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$77.62 / $95.50 / $302.00
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$169.82 / $295.12 / $891.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.42 / $436.52 / $724.44
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$75.86 / $107.15 / $186.21
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$190.55 / $309.03 / $562.34
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $616.60
Regence BlueShield
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$323.59 / $323.59 / $323.59
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.38 / $524.81 / $776.25
Regence BlueShield
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$120.23 / $158.49 / $218.78
Regence BlueShield
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$288.40 / $371.54 / $575.44
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.19 / $426.58 / $616.60
Select Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$81.28 / $177.83 / $208.93
Select Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$169.82 / $251.19 / $398.11
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.82 / $316.23 / $575.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.04 / $371.54 / $616.60
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$79.43 / $83.18 / $154.88
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$177.83 / $257.04 / $457.09