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Utah rates for HCPCS 75573

Computed tomography, heart, with contrast material, for evaluation of cardiac structure and morphology in the setting of congenital heart disease (including 3D image postprocessing, assessment of left ventricular [LV] cardiac function, right ventricular [RV] structure and function and evaluation of vascular structures, if performed)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$136.16 / $136.16 / $136.16
Regence BlueShield
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$324.95 / $324.95 / $324.95