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Alaska rates for HCPCS 75571

Computed tomography, heart, without contrast material, with quantitative evaluation of coronary calcium

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$87.10 / $123.03 / $154.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.13 / $134.90 / $398.11
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$28.18 / $41.69 / $114.82
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$39.81 / $87.10 / $281.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.00 / $371.54 / $707.95
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$53.70 / $95.50 / $208.93
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$213.80 / $275.42 / $489.78
Moda Health
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$100.00 / $154.88 / $162.18
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.04 / $275.42 / $524.81
Moda Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$43.65 / $81.28 / $158.49
Moda Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$97.72 / $194.98 / $354.81
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.08 / $416.87 / $660.69
Premera BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$102.33 / $109.65 / $181.97
Premera BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$263.03 / $302.00 / $467.74
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.04 / $257.04 / $316.23
Providence
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$23.44 / $87.10 / $208.93
Providence
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$69.18 / $213.80 / $489.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.90 / $371.54 / $812.83
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$70.79 / $120.23 / $263.03
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$169.82 / $251.19 / $549.54