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Michigan 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
$213.80 / $245.47 / $245.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.82 / $208.93 / $275.42
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$165.96 / $165.96 / $165.96
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.49 / $165.96 / $173.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$309.03 / $309.03 / $309.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $251.19 / $933.25
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$245.47 / $245.47 / $245.47
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.97 / $229.09 / $302.00
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$309.03 / $309.03 / $309.03
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $251.19 / $933.25
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.04 / $177.83 / $467.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.88 / $181.97 / $275.42