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Pennsylvania 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
$30.20 / $58.88 / $102.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.61 / $125.89 / $512.86
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$25.70 / $41.69 / $91.20
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$46.77 / $89.13 / $269.15
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.28 / $81.28 / $81.28
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$20.42 / $38.90 / $52.48
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.72 / $102.33 / $181.97
Capital Blue Cross
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$27.54 / $35.48 / $60.26
Capital Blue Cross
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$70.79 / $74.13 / $128.82
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$6.76 / $31.62 / $44.67
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $120.23 / $229.09
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$19.95 / $33.88 / $63.10
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$54.95 / $85.11 / $162.18
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.71 / $134.90 / $169.82
Emblem Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$26.92 / $35.48 / $43.65
Emblem Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$77.62 / $100.00 / $125.89
Geisinger
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.66 / $102.33 / $204.17
Geisinger
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$23.44 / $30.90 / $57.54
Geisinger
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$33.11 / $74.13 / $147.91
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.23 / $128.82 / $134.90
Highmark BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$28.84 / $32.36 / $47.86
Highmark BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$109.65 / $109.65 / $109.65
Martin's Point
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$30.20 / $51.29 / $100.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.44 / $128.82 / $331.13
Martin's Point
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$25.70 / $40.74 / $81.28
Martin's Point
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$44.67 / $91.20 / $208.93
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.88 / $117.49 / $208.93
UPMC Health Plan
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$26.30 / $27.54 / $27.54
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.11 / $97.72 / $346.74
UPMC Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$26.92 / $27.54 / $28.84
UPMC Health Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$69.18 / $70.79 / $79.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $104.71 / $169.82
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$22.91 / $29.51 / $48.98
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$56.23 / $75.86 / $125.89