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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
$187.48 / $270.00 / $957.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$182.36 / $209.09 / $245.75
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$154.79 / $278.62 / $451.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$235.00 / $270.00 / $935.47
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$290.27 / $290.27 / $290.27
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$187.48 / $419.77 / $957.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$183.53 / $209.19 / $275.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$265.89 / $265.89 / $265.89
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$199.58 / $270.47 / $375.66
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$235.00 / $270.00 / $935.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.87 / $119.20 / $205.93