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Idaho rates for HCPCS 0634T

Computed tomography, breast, including 3D rendering, when performed, unilateral; with contrast material(s)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$794.33 / $794.33 / $794.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.83 / $208.93 / $275.42
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$288.40 / $416.87 / $630.96
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.19 / $295.12 / $331.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$245.47 / $501.19 / $602.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $346.74 / $524.81
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.83 / $263.03 / $467.74
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.82 / $208.93 / $371.54
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $77.62
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$331.13 / $467.74 / $630.96
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.42 / $309.03 / $380.19
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.80 / $288.40 / $457.09
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$181.97 / $181.97 / $181.97
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.88 / $190.55 / $371.54