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Maine 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
$891.25 / $891.25 / $891.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.82 / $223.87 / $309.03
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.49 / $158.49 / $323.59
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.42 / $302.00 / $575.44
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$891.25 / $891.25 / $891.25
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $229.09 / $389.05
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $173.78 / $436.52