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Maine 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
$891.25 / $891.25 / $891.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.82 / $223.87 / $309.03
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $190.55 / $323.59
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.88 / $302.00 / $575.44
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$891.25 / $891.25 / $891.25
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $229.09 / $389.05
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.18 / $257.04 / $562.34