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Idaho rates for HCPCS 0633T

Computed tomography, breast, including 3D rendering, when performed, unilateral; without contrast material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$802.00 / $802.00 / $802.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$201.79 / $223.25 / $371.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$148.86 / $307.64 / $367.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$315.48 / $315.48 / $499.46
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$195.24 / $223.25 / $285.76
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$499.46 / $499.46 / $499.46
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $3,900.00
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$208.18 / $290.93 / $356.44
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$253.73 / $298.50 / $313.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.44 / $116.66 / $222.20