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New Hampshire rates for HCPCS 0633T

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.59 / $194.35 / $225.65
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.15 / $217.45 / $348.22
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$640.01 / $640.01 / $1,138.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$600.00 / $600.00 / $600.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$222.18 / $394.86 / $731.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$113.45 / $152.62 / $301.17
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,500.00 / $2,750.00 / $3,500.00