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Utah 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 / $30.20 / $30.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.18 / $114.82 / $501.19
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$25.70 / $38.02 / $85.11
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$47.86 / $85.11 / $316.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.20 / $112.20 / $223.87
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$22.91 / $33.88 / $72.44
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$61.66 / $79.43 / $158.49
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $154.88
Regence BlueShield
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$147.91 / $147.91 / $147.91
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.54 / $190.55 / $229.09
Regence BlueShield
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$38.90 / $51.29 / $63.10
Regence BlueShield
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$104.71 / $134.90 / $162.18
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.50 / $151.36 / $199.53
Select Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$26.30 / $56.23 / $66.07
Select Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$69.18 / $93.33 / $123.03
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.90 / $114.82 / $199.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.28 / $91.20 / $181.97
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$22.91 / $25.12 / $48.98
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$56.23 / $66.07 / $134.90