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Pennsylvania 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
$229.09 / $676.08 / $954.99
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $208.93 / $302.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$154.88 / $288.40 / $588.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.42 / $269.15 / $933.25
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.12 / $295.12 / $295.12
Geisinger
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.03 / $263.03 / $275.42
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$229.09 / $676.08 / $954.99
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.97 / $218.78 / $363.08
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$158.49 / $281.84 / $371.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.20 / $112.20 / $186.21