go back

Wisconsin 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
$199.53 / $389.05 / $389.05
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $208.93 / $302.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.18 / $295.12 / $1,023.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.15 / $288.40 / $338.84
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.55 / $389.05 / $588.84
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.55 / $269.15 / $933.25
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.65 / $190.55 / $1,288.25
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $64.57 / $70.79
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.03 / $457.09 / $660.69
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$467.74 / $2,630.27 / $2,630.27
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.84 / $1,288.25 / $1,288.25
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$275.42 / $275.42 / $363.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.65 / $165.96 / $380.19