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Indiana 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
$407.38 / $645.65 / $1,659.59
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $208.93 / $275.42
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$354.81 / $354.81 / $691.83
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.09 / $354.81 / $562.34
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$194.98 / $1,905.46 / $4,365.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.82 / $131.83 / $1,000.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.19 / $346.74 / $467.74
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$147.91 / $147.91 / $218.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.88 / $181.97 / $316.23